Kathryn Rugen - Academia.edu (original) (raw)

Papers by Kathryn Rugen

Journal of General Internal Medicine, Feb 24, 2015

As American medicine continues to undergo significant transformation, the patient-centered medica... more As American medicine continues to undergo significant transformation, the patient-centered medical home (PCMH) is emerging as an interprofessional primary care model designed to deliver the right care for patients, by the right professional, at the right time, in the right setting, for the right cost. A review of local, state, regional and national initiatives to train professionals in delivering care within the PCMH model reveals some successes, but substantial challenges. Workforce policy recommendations designed to improve PCMH effectiveness and efficiency include 1) adoption of an expanded definition of primary care, 2) fundamental redesign of health professions education, 3) payment reform, 4) responsiveness to local needs assessments, and 5) systems improvement to emphasize quality, population health, and health disparities.

Journal of Professional Nursing, 2020

Background: Doctoral-prepared nurses with diverse skillsets are required to meet nursing care nee... more Background: Doctoral-prepared nurses with diverse skillsets are required to meet nursing care needs in a complex and changing healthcare environment. A better understanding of the roles of doctoral-prepared nurses in Veterans Health Administration (VHA) workforce will help leverage their expertise to meet the needs of Veterans. Purpose: Assess the current roles of doctoral-prepared nurses within the VHA. Method: A cross-sectional survey was used to collect information on doctoral-prepared nurses within the VHA in 2016. Multiple strategies were used to identify doctoral-prepared nurses to recruit for an online survey. Survey invitations were sent electronically to unique individuals identified (N = 2403). Results: Responses were received from 1015 nurses (42.2% response rate), with 929 nurses with a doctoral degree identified. DNP/DNAP degrees were most common (55%), followed by a PhD or DNS (33%). Significant differences were noted between nurses in different doctoral education categories across four main roles: research, clinical, educational, and administration. Conclusions: This survey generated the first comprehensive list of VHA doctoral-prepared nurses. Findings are being used by the VHA Office of Nursing Services to align degree types, duties of different positions, functional statements, and position expectations. Results support the continued need for collaboration between nurses with PhDs and DNPs to achieve research and clinical goals.

Applied Nursing Research, Feb 1, 2018

Journal of Nursing Education and Practice, Jan 23, 2018

Background and objective: Early diagnosis of colorectal cancer (CRC) through screening is associa... more Background and objective: Early diagnosis of colorectal cancer (CRC) through screening is associated with survival rates of more than 90%. Nearly half of American adults are not compliant with recommendations. The purpose of this project is to implement and evaluate an evidenced based protocol utilizing motivational interviewing as an intervention to improve CRC screening rates among a Veteran population. Methods: The project design includes a single session telephone based motivational interviewing session two weeks after receipt of fecal immunochemical test (FIT) for home screening. A motivational interview roadmap was developed to guide the telephone session. Results: All participants were male and 76% had previously completed a CRC screening test. Fourteen percent (n = 7/50) of participants returned their FIT within 2 weeks. Of the 38 participants eligible for telephone based motivational interview 66% (n = 25) were unreachable by telephone and received one or two voicemail messages that stressed the importance of returning the FIT. Of the motivational interviewing recipients, 62% (n = 8/13) successfully returned their FIT. Conclusions: These results provide beginning evidence for the effectiveness of motivational interviewing to improve CRC screening rates. Issues with system processes and healthcare provider behaviors were identified and recommendations for improvement are provided.

Journal of Clinical Nursing, Aug 1, 2012

Aims and objectives. To test the transportability and implementation of the Tobacco Tactics inter... more Aims and objectives. To test the transportability and implementation of the Tobacco Tactics intervention using the Reach, Effectiveness, Adoption, Implementation and Maintenance framework, for inpatient units at the Jesse Brown Veterans Affairs Medical Center. Background. Smoking rates are high among veterans. While the Department of Veterans Affairs has standardised outpatient cessation clinics, inpatient cessation services, known to be efficacious, are only sporadically provided. Design. This was a phase 4, pre and postimplementation study of the Tobacco Tactics intervention. Methods. A unique convenience sample of inpatient veteran smokers was recruited both before (n = 54) and after (n = 50) implementation of the Tobacco Tactics programme. Participants completed baseline and 30-day follow-up surveys along with urine cotinine test kits. In addition, staff completed anonymous surveys during the preintervention period (n = 158) and two months after (n = 81) the Tobacco Tactics training. Bivariate analyses compared preintervention vs. postintervention patient and staff characteristics using Chi-square, Fisher's Exact or Student's t-test. p-values <0AE05 were considered significant. Results. Patient-reported receipt of services and satisfaction was 10% higher in the postintervention compared to the preintervention group. Quit rates were 3% higher in the postintervention than in the preintervention group. The mean number of cigarettes smoked per day increased from 13 to 15 in the preintervention group, while the mean number of cigarettes smoked per day decreased from 14 to 9 in the postintervention group. Staff's confidence in their ability to provide cessation services improved greatly posttraining (p = 0AE0017) as did self-reported delivery of cessation services (p = 0AE0154). Conclusions. With as little as one-hour training for nurses, the Tobacco Tactics intervention has the potential to be widely disseminated in the Department of Veterans Affairs. Relevance to clinical practice. The implementation of inpatient smoking interventions has the potential to improve quit rates and decrease morbidity and mortality in the Department of Veterans Affairs.

Journal of Interprofessional Care, Feb 20, 2018

This paper describes the Centers of Excellence in Primary Care Education (CoEPCE), a seven-site c... more This paper describes the Centers of Excellence in Primary Care Education (CoEPCE), a seven-site collaborative project funded by the Office of Academic Affiliations (OAA) within the Veterans Health Administration of the United States Department of Veterans Affairs (VA). The CoEPCE was established to fulfill OAA's vision of largescale transformation of the clinical learning environment within VA primary care settings. This was accomplished by funding new Centers within VA facilities to develop models of interprofessional education (IPE) to teach health professions trainees to deliver high quality interprofessional team-based primary care to Veterans. Using reports and data collected and maintained by the National Coordinating Center over the first six years of the project, we describe program inputs, the multicomponent intervention, activities undertaken to develop the intervention, and short-term outcomes. The findings have implications for lessons learned that can be considered by others seeking large-scale transformation of education within the clinical workplace and the development of interprofessional clinical learning environments. Within the VA, the CoEPCE has laid the foundation for IPE and collaborative practice, but much work remains to disseminate this work throughout the national VA system.

Nursing Outlook, Mar 1, 2021

Veterans Health Administration (VHA) Office of Nursing Services (ONS) is committed to encouraging... more Veterans Health Administration (VHA) Office of Nursing Services (ONS) is committed to encouraging and sustaining a positive culture that values doctoral-prepared nurses. Responding to needs cited in open-ended responses from the first ever survey of VHA's doctoral-prepared nurse workforce will require: providing and encouraging formal advanced degree achievement recognition; further opportunities for professional development and potential promotion; and support for nurse research activities at the local and national level. ONS recognizes the need for further research and evaluation related to VHA doctoral-prepared nurses to better understand both the outcomes they drive and what drives them.

Nursing Outlook, 2018

Background: The Institute of Medicine has recommended the establishment of residency programs for... more Background: The Institute of Medicine has recommended the establishment of residency programs for advanced practice nursing graduates. Currently, the evidence about program effectiveness is limited. Purpose: To describe the nurse practitioner (NP) resident outcomes on seven competency domains established by the VA Centers of Excellence in Primary Care Education (VA CoEPCE). Methods: We evaluated mean NP resident competency self-ratings and mean mentor ratings over the 12-month program across NP residency programs at five sites. Highest and lowest rated items and differences between NP resident selfratings and mentor ratings were analyzed. Results: Mean NP resident self-ratings and mean mentor ratings demonstrated statistically significant improvement in all domains (p < .0001). At 12 months, NP residents were rated by their mentors as able to practice without supervision in all competency domains. At 1 and 12 months, clinical, leadership and quality improvement/population management competencies were the lowest scored domains while patient-centered care, interprofessional team collaboration, shared decision-making and sustained relationships competencies were highest. Conclusions: These results provide initial evidence for the effectiveness of VA CoEPCE NP residency programs and also highlight areas of needed improvement.

Nursing Outlook, Mar 1, 2014

To integrate health care professional learners into patient-centered primary care delivery models... more To integrate health care professional learners into patient-centered primary care delivery models, the Department of Veterans Affairs has funded five Centers of Excellence in Primary Care Education (CoEPCEs). The main goal of the CoEPCEs is to develop and test innovative structural and curricular models that foster transformation of health care training from profession-specific &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;silos&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; to interprofessional, team-based educational and care delivery models in patient-centered primary care settings. CoEPCE implementation emphasizes four core curricular domains: shared decision making, sustained relationships, interprofessional collaboration, and performance improvement. The structural models allow interprofessional learners to have longitudinal learning experiences and sustained and continuous relationships with patients, faculty mentors, and peer learners. This article presents an overview of the innovative curricular models developed at each site, focusing on nurse practitioner (NP) education. Insights on transforming NP education in the practice setting and its impact on traditional NP educational models are offered. Preliminary outcomes and sustainment examples are also provided.

The Journal for Nurse Practitioners, Jun 1, 2016

Abstract The Institute of Medicine recommended the implementation of nurse practitioner transitio... more Abstract The Institute of Medicine recommended the implementation of nurse practitioner transition-to-practice programs, either called residency or fellowship, for new graduates. These programs are rapidly expanding on the national level in a variety of practice areas. However, there is a lack of literature on the effectiveness of these programs. The Veterans Affairs Centers of Excellence in Primary Care Education developed a competency-based assessment tool to measure program effectiveness, document the achievement of competency, and promote standardization. This article describes the development of the tool along with curricular examples to promote nurse practitioner transition to practice.

Academic Medicine, Aug 1, 2014

ABSTRACT Health systems around the United States are embracing new models of primary care using i... more ABSTRACT Health systems around the United States are embracing new models of primary care using interprofessional team-based approaches in pursuit of better patient outcomes, higher levels of satisfaction among patients and providers, and improved overall value. Less often discussed are the implications of new models of care for health professions education, including education for physicians, nurse practitioners, physician assistants, and other professions engaged in primary care. Described here is the interaction between care transformation and redesign of health professions education at the largest integrated delivery system in the United States: the Veterans Health Administration (VA). Challenges and lessons learned are discussed in the context of a demonstration initiative, the VA Centers of Excellence in Primary Care Education. Five sites, involving VA medical centers and their academic affiliates in Boise, Cleveland, San Francisco, Seattle, and West Haven, introduced interprofessional primary care curricula for resident physicians and nurse practitioner students beginning in 2011. Implementation struggles largely revolved around the operational logistics and cultural disruption of integrating educational redesign for medicine and nursing and facilitating the interface between educational and clinical activities. To realize new models for interprofessional teaching, faculty, staff, and trainees must understand the histories, traditions, and program requirements across professions and experiment with new approaches to achieving a common goal. Key recommendations for redesign of health professions education revolve around strengthening the union between interprofessional learning, team-based practice, and high-value care.

Nursing Outlook, Jul 1, 2018

Background: Nurse Practitioner (NP) Postgraduate Residency programs are rapidly expanding. Curren... more Background: Nurse Practitioner (NP) Postgraduate Residency programs are rapidly expanding. Currently, little is known about trainees' self-perceptions during these experiences. Purpose: Describe NP residents' perceptions of their strengths, areas for improvement, and goals while participating in the Veterans Affairs Centers of Excellence in Primary Care Education NP Residency program. Methods: NP residents responded to open-ended questions at three time points across their training year. Responses were analyzed using inductive and deductive approaches. Findings: NP residents self-reported strengths in patient-centered care and interprofessional teamwork. They identified clinical skill acquisition as the major area for improvement. Their short-and long-term goals focused on personal and professional growth. Discussion: These results suggest NPs prioritize clinical skill acquisition during a primary care residency. In contrast, leadership and performance improvement skills did not capture their attention. When aggregated at the programmatic level, assessments identified opportunities to improve the NP Residency program curriculum.

Annals of Behavioral Medicine, Aug 9, 2011

The diffusion of colorectal cancer screening into clinical and public health practice has contrib... more The diffusion of colorectal cancer screening into clinical and public health practice has contributed to the trend of small decreases in colorectal cancer-related mortality over the past several decades (3); screening, however, remains suboptimal for minorities and older individuals (4). Experts in the U.S. recommend regular colorectal cancer screening starting at age 50 for those at average risk. Screening options include annual fecal occult blood testing (stool blood test); flexible sigmoidoscopy (sigmoidoscopy) every 5 years; sigmoidoscopy every 5 years with annual stool blood test; and colonoscopy every 10 years (2, 5). Screening guidelines in other countries differ slightly from the U.S. and many offer national population-based screening programs. For example, in Australia, stool blood test is strongly recommended at least once every two years; and screening sigmoidoscopy is advised every five years from age 50 (6). In the United Kingdom, England and Wales have chosen to implement biennial stool blood test for all those aged between 60 and 69 years by 2010. Scotland is currently screening those aged between 50 and 74 years. National populationbased programs also exist in Finland, France, Italy, and Poland, and regional based screening in advance of a national program is underway in Portugal, Slovenia, Sweden, and Spain. In Germany, annual stool blood testing is offered for those between 50 and 54 years and colonoscopy for those between 55 and 65 years (7).

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Nursing Outlook, May 1, 2021

Journal of research in interprofessional practice and education, May 31, 2021

Ce document est protégé par la loi sur le droit d'auteur. L'utilisation des services d'Érudit (y ... more Ce document est protégé par la loi sur le droit d'auteur. L'utilisation des services d'Érudit (y compris la reproduction) est assujettie à sa politique d'utilisation que vous pouvez consulter en ligne. https://apropos.erudit.org/fr/usagers/politique-dutilisation/ Cet article est diffusé et préservé par Érudit. Érudit est un consortium interuniversitaire sans but lucratif composé de l'

Medical Care, Sep 1, 2008

Background-Increasing colorectal cancer screening (CRCS) can have a substantial positive impact o... more Background-Increasing colorectal cancer screening (CRCS) can have a substantial positive impact on morbidity and mortality. Objectives-The purpose of this report is to describe the development and feasibility testing of a computer-based, theory-guided educational program designed to increase CRCS. Research Design-This mixed-methods study used focus groups and subsequent randomized controlled trial design. Subjects-Participants (N = 199) were randomized to an intervention or control group; 75% were African American; mean age was 57.36 (SD = 6.8); 71% were male. Measures-Previously validated measures on knowledge, beliefs, and screening test adherence were used to establish pre-and post-intervention perceptions. Feasibility was measured by response and completion rates, and participants' perceptions of the program. Results-Before feasibility testing, the program was presented to 2 focus groups. Changes were made to the program based on discussion, leading to a visually appealing, easy to understand and navigate, self-paced program. In the RCT pilot test that followed, of the participants in the intervention group, 80% said the education helped them decide to get CRCS; 49% agreed it helped them overcome barriers; 91% agreed it was useful, 68% thought it raised new concerns about cancer, but only 30% said it made them worry about CRC; 95% agreed their doctor's office should continue giving such education, and 99% said they would inform family about the program. Conclusions-The response rate of 83% demonstrated feasibility of conducting colorectal cancer education in the primary care setting; overall the program was well received; participants averaged 23 minutes to complete it. Participants sought no help from attending data collectors and navigated the revised touch screen program with ease. Computer-based education is feasible in primary care clinics.

Journal of Professional Nursing

Nursing Outlook, 2021