Margeaux Chavez

PURPOSE: The purpose of this quality improvement project was to develop guidance for safe patient handling and mobility efforts to prevent pressure injuries (PIs) within the Veterans Health Administration (VHA) when slings and other transfer devices are left under patients. PARTICIPANTS AND SETTING: Health care staff (n = 112) in patient safety and nursing at 77 unique VHA facilities responded to surveys between November and December 2019. Interviews (n = 24) were conducted using purposive sampling with VHA staff at facilities with highest and lowest PI rates (n = 9) between January and March 2021. APPROACH: Feedback on practices and perceptions related to leaving slings and other transfer devices were evaluated using online cross-sectional surveys and interviews with VHA staff. Secondary data for VHA inpatient rates of PIs were used to examine associations with staff-reported sling and other transfer device practices. OUTCOMES: Leaving slings under patients was associated with higher proportion of patients developing PIs in intensive care units (ICUs, P = .042) and medical-surgical care units (P = .025). In addition, use of sliding boards for seated transfer among short-stay residents in Community Living Centers was associated with higher PI occurrences (P = .017). Qualitative interviews found perceptions and guidance about PI risk related to slings and other transfer devices varied among staff who consider many factors when determining risk. IMPLICATIONS FOR PRACTICE: There are perceived benefits and risks of leaving slings and other transfer devices under patients and limited knowledge of PI occurrences associated with this practice. Clinical decision support can help staff determine safe sling use. More work is needed to test the safety of common sling and transfer device practices and define best practices for communicating PI risk related to sling and transfer device use across the care continuum.

Background: New graduate registered nurse (RN) competencies are complex and difficult to measure. Psychometrically sound tools are needed to evaluate competencies for nurses participating in nurse residencies. Purpose: Project aims were to develop an item pool for a tool to measure new graduate RN competencies for the Veterans Health Administration RN Transition-to-Practice Residency Program; validate item pool content; and use consensus methods to improve item pool content validity. Methods: A sequential, mixed-methods design was used. Item pool creation, content validation, and revisions included a collaborative process with the evaluation team, operational stakeholders, and subject matter experts (SMEs). Results: Inclusion of SMEs in item development enhanced item pool content validity to measure nurse competency. Stakeholder feedback ensured programmatic logistical and evaluation concerns were met. Conclusions: Engaging SMEs in conceptualization, item development, and aligning existing standards enhanced item pool content validity to measure nurse competencies for new graduate RNs.

Background: Veteran community reintegration (CR) has been defined as participation in community life, including employment or other productive activities, independent living, and social relationships. Veteran CR is a Veterans Health Administration priority, as a substantial proportion of veterans report difficulties with veteran CR following discharge from military service. Objective: Enhancing Veteran Community Reintegration Research (ENCORE) is a project funded by Veterans Health Administration’s Health Service Research and Development Service. The goal of ENCORE is to maximize veteran and family reintegration by promoting innovative research and knowledge translation (KT) that informs and improves equitable Department of Veterans Affairs (VA) policies, programs, and services. Overall, 2 strategic objectives guide ENCORE activities: mobilize veteran CR research and promote innovation, relevance, and acceleration of veteran CR research and KT. Methods: ENCORE uses a mixed methods and stakeholder-engaged approach to achieve objectives and to ensure that the KT products generated are inclusive, innovative, and meaningful to stakeholders. Project activities will occur over 5 years (2019-2024) in 5 phases: plan, engage, mobilize, promote, and evaluate. All activities will be conducted remotely owing to the ongoing COVID-19 pandemic. Methods used will include reviewing research funding and literature examining the gaps in veteran CR research, conducting expert informant interviews with VA program office representatives, and assembling and working with a Multistakeholder Partnership (MSP). MSP meetings will use external facilitation services, group facilitation techniques adapted for virtual settings, and a 6-step group facilitation process to ensure successful execution of meetings and accomplishment of goals. Results: As of December 2022, data collection for ENCORE is ongoing, with the team completing interviews with 20 stakeholders from 16 VA program offices providing veteran CR–related services. ENCORE developed and assembled the MSP, reviewed the VA funding portfolio and veteran CR research literature, and conducted a scientific gap analysis. The MSP developed a veteran CR research agenda in 2021 and continues to work with the ENCORE team to prepare materials for dissemination. Conclusions: The goal of this program is to improve the impact of veteran CR research on policies and programs. Using a stakeholder-engaged process, insights from key stakeholder groups are being incorporated to set a research agenda that is more likely to result in a relevant and responsive veteran CR research program. Future products will include the development of an effective and relevant dissemination plan and the generation of innovative and relevant dissemination products designed for rapid KT. International Registered Report Identifier (IRRID): DERR1-10.2196/42029

Background: Assisted falls occur when staff try to minimize the impact of falls by slowing a patient’s descent. Assisting a patient fall may decrease patient injury risk, but biomechanical risk of injury to staff has not been evaluated. Assisted falls virtual reality (VR) simulations were conducted to examine staff low back injury risk during common assisted falls scenarios. Methods: VR simulations of a toilet to wheelchair transfer were developed with a male patient avatar for three assisted falls scenarios: standing up from toilet, sitting down on wheelchair, and ambulation. Patient avatar weight was modified to reflect normal, underweight, and overweight adult patients. The average spinal compression force at L5/S1 was calculated for each participant with five trials per three scenarios while utilizing physical ergonomic techniques and compared to the safe spinal compression limit of 3,400 Newtons (N). Findings: Six staff participants completed 90 VR simulations in total. The average calculated spinal compression force ranged from 7,132 N to 27,901 N. All participant trials exceeded the safe spinal compression limit of 3,400 N for every assisted falls scenario and avatar weight despite application of ergonomic techniques including wide stance, knees bent, and backs straight. Conclusions/Application to Practice: Staff are at risk for low back injury if they assist falls regardless of the adult patient weight and application of ergonomic techniques. Safer alternatives like the implementation of mobility screening tools and safe patient handling and mobility technology are needed to help prevent assisted falls to decrease injury risk to both patients and staff.

Background: Veterans Affairs Farming and Recovery Mental Health Services (VA FARMS) is an innovative pilot program to provide supportive resources for veterans with interests in agricultural vocations. Implemented at 10 pilot sites, VA FARMS will provide mental health services and resources for veterans while supporting training in gardening and agriculture. As each pilot site project has unique goals, outreach strategies, and implementation efforts based on the local environment and veteran population, evaluating the pilot program provides a unique challenge for evaluators. This paper describes the protocol to evaluate VA FARMS, which was specifically designed to enable site variation by providing both site-specific and cross-site understanding of site implementation processes and outcomes. Objective: The objectives of this paper are to (1) describe the protocol used for evaluating VA FARMS, as an innovative Department of Veterans Affairs (VA) agriculturally based, mental health, and employment pilot program serving veterans at 10 pilot sites across the Veterans Health Administration enterprise; and (2) provide guidance to other evaluators assessing innovative programs. Methods: This evaluation uses the context, inputs, process, product (CIPP) model, which evaluates a program’s content and implementation to identify strengths and areas for improvement. Data collection will use a concurrent mixed methods approach. Quantitative data collection will involve quarterly program surveys, as well as three individual veteran participant surveys administered upon the veteran’s entrance and exit of the pilot program and 3 months postexit. Quantitative data will include baseline descriptive statistics and follow-up statistics on veteran health care utilization, health care status, and agriculture employment status. Qualitative data collection will include participant observation at each pilot site, and interviews with participants, staff, and community stakeholders. Qualitative data will provide insights about pilot program implementation processes, veterans’ experiences, and short-term participation outcomes. Results: Evaluation efforts began in December 2018 and are ongoing. Between October 2018 and September 2020, 494 veterans had enrolled in VA FARMS and 1326 veterans were reached through program activities such as demonstrations, informational presentations, and town-hall discussions. A total of 1623 community members and 655 VA employees were similarly reached by VA FARMS programming during that time. Data were collected between October 2018 and September 2020 in the form of 336 veteran surveys, 30 veteran interviews, 27 staff interviews, and 11 community partner interviews. Data analysis is expected to be completed by October 2022. Conclusions: This evaluation protocol will provide guidance to other evaluators assessing innovative programs. In its application to the VA FARMS pilot, the evaluation aims to add to existing literature on nature-based therapies and the rehabilitation outcomes of agricultural training programs for veterans. Results will provide programmatic insights on the implementation of pilot programs, along with needed improvements and modifications for the future expansion of VA FARMS and other veteran-focused agricultural programs. International Registered Report Identifier (IRRID): DERR1-10.2196/40496

BACKGROUND Veteran community reintegration (CR) has been defined as participation in community life, including employment or other productive activities, independent living, and social relationships. Veteran CR is a Veterans Health Administration priority, as a substantial proportion of veterans report difficulties with veteran CR following discharge from military service. OBJECTIVE Enhancing Veteran Community Reintegration Research (ENCORE) is a project funded by Veterans Health Administration’s Health Service Research and Development Service. The goal of ENCORE is to maximize veteran and family reintegration by promoting innovative research and knowledge translation (KT) that informs and improves equitable Department of Veterans Affairs (VA) policies, programs, and services. Overall, 2 strategic objectives guide ENCORE activities: mobilize veteran CR research and promote innovation, relevance, and acceleration of veteran CR research and KT. METHODS ENCORE uses a mixed methods and stakeholder-engaged approach to achieve objectives and to ensure that the KT products generated are inclusive, innovative, and meaningful to stakeholders. Project activities will occur over 5 years (2019-2024) in 5 phases: plan, engage, mobilize, promote, and evaluate. All activities will be conducted remotely owing to the ongoing COVID-19 pandemic. Methods used will include reviewing research funding and literature examining the gaps in veteran CR research, conducting expert informant interviews with VA program office representatives, and assembling and working with a Multistakeholder Partnership (MSP). MSP meetings will use external facilitation services, group facilitation techniques adapted for virtual settings, and a 6-step group facilitation process to ensure successful execution of meetings and accomplishment of goals. RESULTS As of December 2022, data collection for ENCORE is ongoing, with the team completing interviews with 20 stakeholders from 16 VA program offices providing veteran CR–related services. ENCORE developed and assembled the MSP, reviewed the VA funding portfolio and veteran CR research literature, and conducted a scientific gap analysis. The MSP developed a veteran CR research agenda in 2021 and continues to work with the ENCORE team to prepare materials for dissemination. CONCLUSIONS The goal of this program is to improve the impact of veteran CR research on policies and programs. Using a stakeholder-engaged process, insights from key stakeholder groups are being incorporated to set a research agenda that is more likely to result in a relevant and responsive veteran CR research program. Future products will include the development of an effective and relevant dissemination plan and the generation of innovative and relevant dissemination products designed for rapid KT. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/42029

Veteran communities including veterans, their families, and their caregivers are vital collaborators in the field of veterans studies. Veteran community engaged research (CEnR) generates findings that are impactful and applicable to target populations. Veteran CEnR is a valuable emerging methodological approach. In the two decades since 9/11, clinical and health services researchers have increasingly prioritized participatory veteran research designs. The purpose of this article is to illustrate the important application of veteran CEnR to the development of a US Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D) research agenda that tackles a nuanced subject—veteran community reintegration. The Enhancing Veteran Community Reintegration Research (ENCORE) project includes a multi-stakeholder partnership (MSP) that engages veterans, families and caregivers, VA program directors, leaders in veteran community reintegration research, and representatives from community based veteran service organizations. Veteran CEnR was used as an approach to co-author this article with MSP research partners. Contributions from MSP volunteer authors are woven throughout the article to illustrate the organization and functioning of the MSP and impact of this type of stakeholder engagement throughout the project.

BACKGROUND Veterans Affairs Farming and Recovery Mental Health Services (VA FARMS) is an innovative pilot program that will provide supportive resources for veterans with interests in agricultural vocation. Implemented at 10 pilot sites, VA FARMS will provide mental health services and resources for veterans while simultaneously supporting training in gardening and agriculture. As each pilot site project has unique goals, outreach strategies, and implementation efforts based on the local environment and veteran population, evaluating the pilot program provides a unique challenge for evaluators. This paper describes the protocol which will be used to evaluate VA FARMS, which has been specifically designed to allow for site variation by providing both site-specific and cross-site understandings of site implementation processes and outcomes. OBJECTIVE The objectives of this paper are to (1) describe the protocol that will be used for evaluating an innovative Department of Veterans Affairs (VA) agriculturally based, mental health, and employment pilot program which serves veterans at ten pilot sites across the VHA enterprise and (2) provide guidance to other evaluators who are assessing innovative programs. METHODS This evaluation uses the Context, Inputs, Process, Product (CIPP) model, which is designed to evaluate a program’s content and implementation strategies to identify strengths and areas for improvement, enhancing program effectiveness and planning efforts. Data collection for the evaluation will use a concurrent mixed methods approach, including both quantitative and qualitative methodologies. Quantitative data collection will take place using Quarterly Program Surveys, as well as three Individual Veteran Participant Surveys administered at the veteran’s entrance and exit of the pilot program and 3 months later. Quantitative data will provide baseline descriptive statistics and follow-up statistics on veteran health care utilization, health care status, and agriculture employment status. Qualitative data collection will include participant observation at each pilot site and interviews with participants, staff, and community stakeholders. Qualitative data will include insights about pilot program implementation processes, veterans’ experiences, and short-term participation outcomes. RESULTS Evaluation efforts began in December 2018 and are ongoing. Between October 2018 and September 2020, a total of 494 veterans had enrolled in VA FARMS, and 1,326 veterans were reached through program activities like demonstrations, informational presentations, and town-hall discussions. In addition, a total of 1,623 community members and 655 VA employees were similarly reached by VA FARMS programming during that time. Data was collected between October 2018 and September 2020 in the form of 336 veteran surveys, 30 veteran interviews, 27 staff interviews, and 11 community partner interviews. Data analysis is expected to be completed by October 2022. CONCLUSIONS This evaluation protocol will provide guidance to other evaluators who are assessing innovative programs. In its application to the VA FARMS pilot, the evaluation aims adds to existing literature on nature-based therapies (NBTs) and the rehabilitation outcomes of agricultural training programs for veterans. When evaluation is complete in late 2022, results will provide programmatic insights on the implementation of pilot programs and needed improvements and modifications for the future expansion of VA FARMS and other veteran-focused agricultural programs.