Developing a Comprehensive Midwifery Assessment Tool: Seeing the Whole Person

2021 ◽  
Vol 66 (6) ◽  
pp. 719-724
Author(s):  
Kimberly Kelstone ◽  
Rakiya Watts ◽  
Heather Findletar Hines
Keyword(s):  
Assessment Tool ◽  
Whole Person

Seeing the Whole Person: Feasibility of Using the Omaha System to Describe Strengths of Older Adults With Chronic Illness

2014 ◽  
Vol 28 (4) ◽  
pp. 299-315 ◽  
Author(s):  
Karen A. Monsen ◽  
Diane E. Holland ◽  
Ping W. Fung-Houger ◽  
Catherine E. Vanderboom
Keyword(s):  
Older Adults ◽  
Chronic Illness ◽  
Health Care Professionals ◽  
Assessment Tool ◽  
Well Being ◽  
Chronic Illnesses ◽  
Assessment Tools ◽  
Whole Person ◽  
Omaha System ◽  
Standardized Terminology

A promising strategy for enhancing care and self-management of chronic illness is an integrative, whole-person approach that recognizes and values well-being. Assessment tools are needed that will enable health care professionals to perceive patients as whole persons, with strengths as well as problems. The purpose of this study was to examine the feasibility of using a standardized terminology (theOmaha System) to describe strengths of older adults with chronic illness. The Omaha System assessment currently consists of identifying signs/symptoms for 42 health concepts. Researchers mapped self-reported strengths phrases to Omaha System concepts using existing narratives of 32 older adults with 12–15 comorbid conditions. Results demonstrated the feasibility of describing strengths of patients with chronic illness. Exploratory analysis showed that there were 0–9 strengths per patient, with unique strengths profiles for 30 of 32 patients. Given that older adults with multiple chronic illnesses also have strengths that can be classified and quantified using the Omaha System, there is potential to use the Omaha System as a whole-person assessment tool that enables perception of both problems and strengths. Further research is needed to enhance the Omaha System to formally represent strengths-based as well as a problem-focused perspectives.

"Cancer Life ReiMagined:" The CaLM model of whole-person cancer care.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 74-74
Author(s):  
Rebekkah Schear ◽  
S. Gail Eckhardt ◽  
Elizabeth Ann Kvale ◽  
Robin Richardson ◽  
Barbara L. Jones
Keyword(s):  
Cancer Care ◽  
Assessment Tool ◽  
Care Delivery ◽  
Psychosocial Assessment ◽  
Care Plan ◽  
Initial Visit ◽  
Use Of Resources ◽  
Patient Reported ◽  
Whole Person ◽  
Swat Team

74 Background: Despite advances in cancer treatment, the orientation of our health system does not address the whole cancer patient or support the wellbeing of the heart, soul, and mind. We launched the CaLM Model of Whole Person Cancer Care, an oncology medical home approach that integrates high acuity, sub-specialty clinical cancer care with comprehensive, ongoing supportive care. The CaLM Model operationalizes the six components in the conceptual framework set forth in the NASEM’s 2013 report. Delivering High-Quality Cancer Care. Methods: Beginning December 2018, we piloted a “flipped” ambulatory care model in GYN and GI oncology delivering daily care through a subset of providers, the SWAT Team: a palliative NP, med onc NP, clinical social worker, and navigator. The SWAT Team triages all physical and social needs. As opposed to anchoring care with the oncologist and referring the patient out to social services, the SWAT team anchors care and the oncologist plugs in for treatment planning. The CaLM Model also utilizes coordinated, interdisciplinary care including financial and fertility navigation, nutrition, genetic counseling, pharmacy, and psychiatry, to manage the patient’s needs via a team-based approach by assessing and addressing the patient’s needs according to their values and preferences. We designed a new clinical and psychosocial assessment tool and patient-facing care plan; launched a Multi-Disciplinary “whole-person” case review process with all interdisciplinary providers and measured patient reported outcomes using the FACT-G, PHQ, GAD, and MD Anderson Symptom Inventory at baseline (initial visit) and every clinical visit. Measured at initial visit and every 6 months. Results: Early data show that the CaLM Model reduces patient symptom burden while improving quality of life. Conclusions: The CaLM Model is an efficient use of resources, compared to a traditional oncologist-focused model of cancer care. Further research is underway to assess cost benefit to the system, the patient and the payers. Ultimately, the CaLM Model may shift the paradigm of cancer care by demonstrating the feasibility and effectiveness of a patient-centered model of care delivery that builds a foundation for a value-based payment model.

Age Norms for Auditory-Perceptual Neurophonetic Parameters: A Prerequisite for the Assessment of Childhood Dysarthria

2020 ◽  
Vol 63 (4) ◽  
pp. 1071-1082
Author(s):  
Theresa Schölderle ◽  
Elisabet Haas ◽  
Wolfram Ziegler
Keyword(s):  
Assessment Tool ◽  
Developmental Trajectories ◽  
Voice Quality ◽  
Typically Developing ◽  
Typically Developing Children ◽  
Age Norms ◽  
Elementary School Age ◽  
Speech Characteristics ◽  
Substantial Progress ◽  
Computer Based

Purpose The aim of this study was to collect auditory-perceptual data on established symptom categories of dysarthria from typically developing children between 3 and 9 years of age, for the purpose of creating age norms for dysarthria assessment. Method One hundred forty-four typically developing children (3;0–9;11 [years;months], 72 girls and 72 boys) participated. We used a computer-based game specifically designed for this study to elicit sentence repetitions and spontaneous speech samples. Speech recordings were analyzed using the auditory-perceptual criteria of the Bogenhausen Dysarthria Scales, a standardized German assessment tool for dysarthria in adults. The Bogenhausen Dysarthria Scales (scales and features) cover clinically relevant dimensions of speech and allow for an evaluation of well-established symptom categories of dysarthria. Results The typically developing children exhibited a number of speech characteristics overlapping with established symptom categories of dysarthria (e.g., breathy voice, frequent inspirations, reduced articulatory precision, decreased articulation rate). Substantial progress was observed between 3 and 9 years of age, but with different developmental trajectories across different dimensions. In several areas (e.g., respiration, voice quality), 9-year-olds still presented with salient developmental speech characteristics, while in other dimensions (e.g., prosodic modulation), features typically associated with dysarthria occurred only exceptionally, even in the 3-year-olds. Conclusions The acquisition of speech motor functions is a prolonged process not yet completed with 9 years. Various developmental influences (e.g., anatomic–physiological changes) shape children's speech specifically. Our findings are a first step toward establishing auditory-perceptual norms for dysarthria in children of kindergarten and elementary school age. Supplemental Material https://doi.org/10.23641/asha.12133380

Exploring the Validity and Operational Impact of Using Allied Health Assistants to Conduct Dysphagia Screening for Low-Risk Patients Within the Acute Hospital Setting

2020 ◽  
Vol 29 (4) ◽  
pp. 1944-1955 ◽  
Author(s):  
Maria Schwarz ◽  
Elizabeth C. Ward ◽  
Petrea Cornwell ◽  
Anne Coccetti ◽  
Pamela D'Netto ◽  
...  
Keyword(s):  
At Risk ◽  
Allied Health ◽  
Assessment Tool ◽  
Hospital Setting ◽  
Low Risk ◽  
False Negatives ◽  
Exact Agreement ◽  
Risk Patients ◽  
Impact Phase ◽  
Operational Impact

Purpose The purpose of this study was to examine (a) the agreement between allied health assistants (AHAs) and speech-language pathologists (SLPs) when completing dysphagia screening for low-risk referrals and at-risk patients under a delegation model and (b) the operational impact of this delegation model. Method All AHAs worked in the adult acute inpatient settings across three hospitals and completed training and competency evaluation prior to conducting independent screening. Screening (pass/fail) was based on results from pre-screening exclusionary questions in combination with a water swallow test and the Eating Assessment Tool. To examine the agreement of AHAs' decision making with SLPs, AHAs ( n = 7) and SLPs ( n = 8) conducted an independent, simultaneous dysphagia screening on 51 adult inpatients classified as low-risk/at-risk referrals. To examine operational impact, AHAs independently completed screening on 48 low-risk/at-risk patients, with subsequent clinical swallow evaluation conducted by an SLP with patients who failed screening. Results Exact agreement between AHAs and SLPs on overall pass/fail screening criteria for the first 51 patients was 100%. Exact agreement for the two tools was 100% for the Eating Assessment Tool and 96% for the water swallow test. In the operational impact phase ( n = 48), 58% of patients failed AHA screening, with only 10% false positives on subjective SLP assessment and nil identified false negatives. Conclusion AHAs demonstrated the ability to reliably conduct dysphagia screening on a cohort of low-risk patients, with a low rate of false negatives. Data support high level of agreement and positive operational impact of using trained AHAs to perform dysphagia screening in low-risk patients.

Measuring “Language Access Profiles” in Deaf and Hard-of-Hearing Children With the DHH Language Exposure Assessment Tool

2020 ◽  
pp. 1-25
Author(s):  
Matthew L. Hall ◽  
Stephanie De Anda
Keyword(s):  
Cluster Analysis ◽  
Exposure Assessment ◽  
Hard Of Hearing ◽  
Assessment Tool ◽  
Communication Mode ◽  
Developmental Potential ◽  
Language Access ◽  
Retest Reliability ◽  
Language Exposure ◽  
Test Retest Reliability

Purpose The purposes of this study were (a) to introduce “language access profiles” as a viable alternative construct to “communication mode” for describing experience with language input during early childhood for deaf and hard-of-hearing (DHH) children; (b) to describe the development of a new tool for measuring DHH children's language access profiles during infancy and toddlerhood; and (c) to evaluate the novelty, reliability, and validity of this tool. Method We adapted an existing retrospective parent report measure of early language experience (the Language Exposure Assessment Tool) to make it suitable for use with DHH populations. We administered the adapted instrument (DHH Language Exposure Assessment Tool [D-LEAT]) to the caregivers of 105 DHH children aged 12 years and younger. To measure convergent validity, we also administered another novel instrument: the Language Access Profile Tool. To measure test–retest reliability, half of the participants were interviewed again after 1 month. We identified groups of children with similar language access profiles by using hierarchical cluster analysis. Results The D-LEAT revealed DHH children's diverse experiences with access to language during infancy and toddlerhood. Cluster analysis groupings were markedly different from those derived from more traditional grouping rules (e.g., communication modes). Test–retest reliability was good, especially for the same-interviewer condition. Content, convergent, and face validity were strong. Conclusions To optimize DHH children's developmental potential, stakeholders who work at the individual and population levels would benefit from replacing communication mode with language access profiles. The D-LEAT is the first tool that aims to measure this novel construct. Despite limitations that future work aims to address, the present results demonstrate that the D-LEAT represents progress over the status quo.

Quick Consult: Quick Consult: Acromioplasty

2002 ◽  
Vol 7 (3) ◽  
pp. 4-5
Keyword(s):  
Glasgow Coma Scale ◽  
Outcome Assessment ◽  
High Probability ◽  
Vegetative State ◽  
Behavioral Impairment ◽  
Whole Person ◽  
Ordinal Scales ◽  
Probability Of Death ◽  
The Individual ◽  
Assessment Scales

Abstract Different jurisdictions use the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) for different purposes, and this article reviews a specific jurisdictional definition in the Province of Ontario of catastrophic impairment that incorporates the AMA Guides. In Ontario, a whole person impairment (WPI) exceeding 54% or a mental or behavioral impairment of Class 4 or 5 qualifies the individual for catastrophic benefits, and individuals who do not meet the test receive a lesser benefit. By inference, this establishes a parity threshold among dissimilar injuries and dissimilar outcome assessment scales for benefits. In Ontario, the Glasgow Coma Scale (GCS) identifies patients who have a high probability of death or of severely disabled survival. The GCS recognizes gradations of vegetative state and disability, but translating the gradations for rating individual impairment on ordinal scales into a method of assessing percentage impairments cannot be done reliably, as explained in the AMA Guides, Fifth Edition. The AMA Guides also notes that mental and behavioral impairment in Class 4 (marked impairment) or 5 (extreme impairment) indicates “catastrophic impairment” by significantly impeding useful functioning (Class 4) or significantly impeding useful functioning and implying complete dependency on another person for care (Class 5). Translating the AMA Guides guidelines into ordinal scales cannot be done reliably.

Combining Values

2002 ◽  
Vol 7 (2) ◽  
pp. 1-4, 12 ◽  
Author(s):  
Christopher R. Brigham
Keyword(s):  
Lower Extremity ◽  
Upper Extremity ◽  
Evaluation Method ◽  
Proximal Phalanx ◽  
Common Error ◽  
The Third ◽  
Whole Person ◽  
Impairment Ratings ◽  
Upper Extremity Impairment ◽  
The Individual

Abstract To account for the effects of multiple impairments, evaluating physicians must provide a summary value that combines multiple impairments so the whole person impairment is equal to or less than the sum of all the individual impairment values. A common error is to add values that should be combined and typically results in an inflated rating. The Combined Values Chart in the AMA Guides to the Evaluation of Permanent Impairment, Fifth Edition, includes instructions that guide physicians about combining impairment ratings. For example, impairment values within a region generally are combined and converted to a whole person permanent impairment before combination with the results from other regions (exceptions include certain impairments of the spine and extremities). When they combine three or more values, physicians should select and combine the two lowest values; this value is combined with the third value to yield the total value. Upper extremity impairment ratings are combined based on the principle that a second and each succeeding impairment applies not to the whole unit (eg, whole finger) but only to the part that remains (eg, proximal phalanx). Physicians who combine lower extremity impairments usually use only one evaluation method, but, if more than one method is used, the physician should use the Combined Values Chart.

Impairment Tutorial: Recurrent Radioculpathy: Recurrent Radioculpathy and Apportionment

2002 ◽  
Vol 7 (4) ◽  
pp. 8-10
Author(s):  
Christopher R. Brigham ◽  
Leon H. Ensalada
Keyword(s):  
Lumbar Spine ◽  
Range Of Motion ◽  
Disk Herniation ◽  
Fourth Edition ◽  
Recurrent Injury ◽  
Injury Model ◽  
Whole Person ◽  
Spinal Region

Abstract Recurrent radiculopathy is evaluated by a different approach in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, compared to that in the Fourth Edition. The AMA Guides, Fifth Edition, specifies several occasions on which the range-of-motion (ROM), not the Diagnosis-related estimates (DRE) method, is used to rate spinal impairments. For example, the AMA Guides, Fifth Edition, clarifies that ROM is used only for radiculopathy caused by a recurrent injury, including when there is new (recurrent) disk herniation or a recurrent injury in the same spinal region. In the AMA Guides, Fourth Edition, radiculopathy was rated using the Injury Model, which is termed the DRE method in the Fifth Edition. Also, in the Fourth Edition, for the lumbar spine all radiculopathies resulted in the same impairment (10% whole person permanent impairment), based on that edition's philosophy that radiculopathy is not quantifiable and, once present, is permanent. A rating of recurrent radiculopathy suggests the presence of a previous impairment rating and may require apportionment, which is the process of allocating causation among two or more factors that caused or significantly contributed to an injury and resulting impairment. A case example shows the divergent results following evaluation using the Injury Model (Fourth Edition) and the ROM Method (Fifth Edition) and concludes that revisions to the latter for rating permanent impairments of the spine often will lead to different results compared to using the Fourth Edition.

Nonspecific Chronic Back Pain: Sixth Edition Approaches

2019 ◽  
Vol 24 (5) ◽  
pp. 14-15
Author(s):  
Jay Blaisdell ◽  
James B. Talmage
Keyword(s):  
Back Pain ◽  
Chronic Back Pain ◽  
Intervertebral Disk ◽  
Key Factors ◽  
Sixth Edition ◽  
Whole Person ◽  
Class 1 ◽  
A Cell ◽  
Intervertebral Disk Herniation ◽  
The Individual

Abstract Ratings for “non-specific chronic, or chronic reoccurring, back pain” are based on the diagnosis-based impairment method whereby an impairment class, usually representing a range of impairment values within a cell of a grid, is selected by diagnosis and “specific criteria” (key factors). Within the impairment class, the default impairment value then can be modified using non-key factors or “grade modifiers” such as functional history, physical examination, and clinical studies using the net adjustment formula. The diagnosis of “nonspecific chronic, or chronic reoccurring, back pain” can be rated in class 0 and 1; the former has a default value of 0%, and the latter has a default value of 2% before any modifications. The key concept here is that the physician believes that the patient is experiencing pain, yet there are no related objective findings, most notably radiculopathy as distinguished from “nonverifiable radicular complaints.” If the individual is found not to have radiculopathy and the medical record shows that the patient has never had clinically verifiable radiculopathy, then the diagnosis of “intervertebral disk herniation and/or AOMSI [alteration of motion segment integrity] cannot be used.” If the patient is asymptomatic at maximum medical improvement, then impairment Class 0 should be chosen, not Class 1; a final whole person impairment rating of 1% indicates incorrect use of the methodology.

Sign in / Sign up

Export Citation Format

Share Document