Background: There are over 2.9 million Registered Nurses (hereafter nurses) in the United States, making nurses the largest group of healthcare workers. Of these, nearly 1.7 million nurses work in the acute care hospital settings. The recent novel coronavirus pandemic caused significant disruptions in the nurses’ ability to do their work safely and effectively due to shortages in equipment, staffing, information as well as conflicting priorities between nurses and their organizations. These experiences have highlighted the importance of interactions between nurses and the organizations within which they work and who set policies regarding their practices.Purpose: The specific aims of the study are 1) describe nurses’ experiences working during the pandemic; 2) examine nurses’ goals and priorities regarding their work during the pandemic; 3) describe how these experiences have shaped their relationships towards their leaders and organizations; and 4) develop a conceptual framework to explain how nurses navigate mechanisms of clinical governance (policies, regulations, official recommendations, best practice statements and others) and which helps identify potential strategies for improving nurses’ ability to do their work safely and effectively. Methods: A qualitative study based on focus group data and a grounded-theory methodological approach was conducted via video teleconferencing with nurses from the United States. The participants also completed an online demographic questionnaire. Convenience sampling of participants was conducted, and participants recruited via social media. A series of semi-structured focus groups were conducted, recorded and transcripts produced. The data from these focus groups were analyzed with qualitative data analysis software and pertinent codes were generated. These codes’ relations were mapped via the same software and conceptual overlap identified. Results: From the above analysis, three critical challenges emerged from the participants’ responses: 1) widespread leadership failures; 2) overwhelming uncertainty and ambiguity; and 3) unprecedented physical and psychosocial vulnerability. Given the centrality of these challenges in nurses’ experiences, a novel approach to nursing leadership was developed. This approach, based upon the tenets of Trauma Informed Care, are proposed as a means of leading while supporting and caring for a team of nurses. Finally, the focus-group data inspired a theoretical exploration of the roles of vulnerability, interdependence and agency in nursing practice through the lens of Actor-Network Theory. Conclusion: The study found that nurses, vulnerable to the physical and psychosocial effects of their work even at the best of times, experienced extreme vulnerability during the pandemic. This was exacerbated by the failure of leadership that many nurses reported. Nurses expected their organization, and those with the institutional power within them, to support and protect them as they faced the pandemic and its many challenges. Instead, they too often felt abandoned and sacrificed. But nurses pushed back strategically to pursue their goals. Nurses are indeed vulnerable, but are also agentive, professional actors who leverage relations with others to shape their work and workplaces in ways which align with their own values. Relations between actors shape and define the experiences of all involved, for better or worse. Perhaps there is a role for a trauma informed leadership in nursing to shape these relations into networks of mutual support and care for a more effective, genuine and humane nursing practice.

Background: Alzheimer’s dementia and related dementias (hereafter dementia) can affect sleep disturbance (e.g., nighttime awakening behaviors and poor sleep quality among persons with dementia (PWD). Estimates suggest sleep problems affect approximately 60-70% of PWD such as the difficulty of falling asleep and multiple wakes at night resulting in advanced cognitive impairment. In addition to the impact of sleep disturbance on PWD, sleep disturbance also is one of the foremost health problems affecting family caregivers of PWD. Family caregivers (e.g., spouses, partners, and adult children) experience the increased awakenings and demands of PWD at night which is associated with increased stress, depressive symptoms, and burden of caregivers. Little research has investigated dyadic interrelationships in sleep quality among PWD and family caregivers. PWD are often excluded from participation in sleep research due to memory deficits and impaired expressive language. Also, immigrant ethnic minorities (e.g., Korean Americans) are also understudied in sleep research. To fully understand sleep quality among PWD-caregiver dyads, we should include both perspectives together. Purpose: The specific aims of the study are (1) to describe dyads’ sleep parameters (i.e., total/deep/REM/light sleep duration, awaken duration, latency duration, sleep efficiency) using wearable technology (i.e., smart ring) and sleep diaries, (2) to identify interrelationships of sleep parameters between PWD and caregivers, and (3) to describe lived experiences of sleep disturbances and sleep interrelationships of PWD and their family caregivers. Methods: An observational descriptive study design was used using mixed methods including quantitative and qualitative approaches using wearable devices’ data (i.e., smart ring), daily sleep diaries, surveys, and individual interviews with cohabitating PWD and caregivers. Dyads were recruited in Southern California. Wearable technology (i.e., smart ring) monitored sleep parameters (i.e., total/deep/REM/light sleep duration, awaken duration, latency duration, sleep efficiency) for 4 weeks. Validated questionnaires assessed sleep disturbances and depressive symptoms for dyads, stress, and caregiving burden for caregivers. Thematic analysis was applied to dyads’ interview data transcribed verbatim in English. Caregivers provided verbal consent, plus surrogate consent for their PWD. PWD provided verbal assent. All PWD were assessed for their decision-making capacity. Results: A total of 11 dyads (N=22) participated in the study: mean age of PWD was 82.7 years (SD=2.3); caregivers were 69.1 years (SD=10.2). Nine PWD (18.2%) were male, all caregivers (100%) were female, and 4 dyads (36.4 %) used the same bed. Sleep parameters of deep/REM/ awaken duration/ Sleep efficiency of PWD were significantly correlated with those of caregivers, respectively (All Ps < 0.05). Major themes included (1) linked sleep disturbances between PWD and caregivers, (2) sleep disturbances beyond control, (3) mixed attitudes about sleep quality in dyads, (4) language challenges within and outside the Korean American dyads, and (5) dyadic activity: strategies that improve sleep quality for dyads. Conclusion: Findings demonstrate PWD’s sleep parameters (i.e., deep /REM sleep duration, awaken duration, sleep efficiency) were significantly correlated with caregivers’ ones. Additionally, findings illustrate sleep disturbances of dyads (PWD - caregivers) connected to each other were beyond their control. The Korean American dyads (i.e., parent PWD and offspring caregivers) expressed communication challenges among them and also, they addressed limited community resources available in their primary language. A dyadic approach and wearable device used in this study show the potential to measure objective sleep quality for both PWD and their caregivers, particularly the immigrant population. Future studies should address special attention on dyadic approaches and cultural competency with large samples and diverse ethnic minorities.

Purpose. The purpose of this study was to describe interprofessional collaborative competencies in practice, and barriers to competency enactment, in the setting of a transitional care program for older adults.

Background. The care for older adults with multiple comorbidities is complex, requiring collaboration between multiple health professionals in various settings, creating problems with communication and coordination that result in avoidable readmissions. Interprofessional collaborative competencies have been identified as key skills for health and social services professionals to address quality and safety gaps, particularly in the hospital to home transition for older adults.

Methods. This study was a descriptive qualitative study using a hybrid, deductive-inductive thematic analysis method. The setting was the Community-based Care Transitions Program, a transitional care program for older adults organized around an Area Agency on Aging collaborating with health systems. Research participants were nursing, pharmacy, and public health professionals at the director, manager and clinical staff levels involved with the care transition intervention. The conceptual framework for Core Interprofessional Collaborative Competencies, developed by the Interprofessional Education Collaborative, was used to frame the interview questions and develop the initial deductive coding scheme. This was followed by an inductive thematic analysis.

Results. Overarching interprofessional collaborative processes, such as interprofessional care planning, were described that encompassed multiple previously identified competencies. System factor barriers to interprofessional collaborative competency enactment were defined at the micro level (interactional), meso level (organizational), and macro level (city, county, state and national level). In addition, interprofessional collaborative culture was defined and posited as a facilitator to interprofessional collaboration at the meso level. A new conceptual model of interprofessional collaboration in the context of transition care for older adults emerged from the study findings that combined previously described conceptual models.

Conclusion. This study described interprofessional collaborative culture and interprofessional collaborative processes that added to the understanding of interprofessional collaboration in practice in the context of transition care for older adults. System factor barriers that were identified and described could be proactively addressed to facilitate interprofessional collaboration. Interprofessional collaborative culture could be proactively cultivated within organizations with the goal of promoting health among the older adult population.

Background: The COVID-19 pandemic resulted in rapid increases in telehealth utilization across all age groups. Although older adults had previously been overlooked as the primary focus for disparity-reducing telehealth interventions, their high rates of morbidity and mortality dictate that they now be placed center stage. These changes in healthcare delivery highlight the need to further increase access to telehealthcare for older adults to avoid exacerbation of health disparities. Digital health innovations need to be mobilized to help find better ways to protect older adults.Objective: To effectively implement a geriatric-inclusive telehealth program at an academic medical center, barriers to care must be adequately explored. PICOT: This study posed the following research question: What are ways to mitigate barriers (I) for healthcare providers (P) to provide effective care for geriatric patients via telehealth (O) as compared to usual in-office care (C) during the COVID-19 pandemic (T)? Research Design/Methods: Telehealth barriers and facilitators were identified through semi-structured interviews with two Healthcare Providers (HCPs) and two Information Technologists (IT) employed at a large urban academic medical center’s geriatric specialty clinic. Thematic analysis using the qualitative interview data was conducted. Results: The following telehealthcare themes emerged: (1) improved patient care as the major benefit; (2) the necessity of educational and technical support for telehealth program success, and (3) improving provider utilization. Conclusion: With a well-designed support and educational infrastructure, providers can rapidly deploy telehealth and remote patient monitoring solutions to improve older adult patients’ access to care and improve healthcare outcomes.

Background: The healthcare demands on our current healthcare system will be increasing in the years to come as the older adult population rises. Many of these older adults will have chronic health conditions that will need to be followed and managed. The burden on healthcare calls for patients to have a more active role and responsibility in managing their own health conditions. A team-based digital approach that promotes patient involvement is integral in the future management of these patients.Methods: This project was part of larger parent project regarding telehealth integration for older adults in an academic medical center in California. The purpose of this project was to determine if the integration of a telehealth program in healthcare institutions and the use of home monitoring devices affected self-care behaviors in older adult participants in managing their chronic health conditions. The study analyzed quantitative data collected in electronic health records (EHR) and qualitative data conducted through participant surveys. Results: 9 participants were successful for utilizing the home blood pressure device daily over the two-month course. 15 out of the 20 participants (75%) utilized the home blood pressure device daily for greater than 80% of the two-month course. Of the 11 participants who were given home weight scales, three participants utilized the scale for 100% of the days out of the two-month course. Six participants (54.5%) utilized the scale for more than 80% of the two-month course. The impact of telehealth integration on self-care behaviors was also examined through the data collection of the number of telemedicine visits occurring in the three months prior to the onboarding of participants into the program, during the program, and three months after participants were offboarded from the program. The use of telemedicine did not show any significance when comparing the number of telemedicine appointments attended before, during, and after the program. The survey responses from the participants yielded two overall encompassing themes: 1) increased personal healthcare engagement, and 2) improved empowerment and self-management. Conclusion: This results of the project demonstrated the importance for early support when implementing future telehealth programs in healthcare institutions. The education and consistent support provided by healthcare professionals to individuals in the older adult population was key to achieving optimal participation in self-care behaviors. The APRN has the high-level ability to impart knowledge and meaning to individuals to be motivated and active participants in their own healthcare management.

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