Publications by authors named "Laurra Aagaard"

4 Publications

  • Page 1 of 1

Pilot Randomized Trial of a Recovery Navigator Program for Survivors of Critical Illness With Problematic Alcohol Use.

Crit Care Explor 2019 Oct 14;1(10):e0051. Epub 2019 Oct 14.

Biobehavioral Symptom Science Group, University of Colorado College of Nursing, Aurora, CO.

Many survivors of critical illness have problematic alcohol use, associated with risk of death and hospital readmission. We tested the feasibility, acceptability, treatment fidelity, and potential efficacy of a customized alcohol intervention for patients in ICUs. The intervention was delivered by a Recovery Navigator using principles of motivational interviewing and shared decision-making.

Design: Pilot randomized trial.

Setting: Two urban ICUs in Denver, CO.

Patients: Patients with problematic alcohol use were enrolled prior to hospital discharge.

Interventions: Patients were randomly assigned to usual care, single-session motivational interviewing and shared decision-making, or multisession motivational interviewing and shared decision-making.

Measurements And Main Results: We assessed feasibility via enrollment and attrition, acceptability via patient satisfaction (Client Satisfaction Questionnaire-8), fidelity via observation and questionnaires, and potential efficacy via group means and CIs on measures of alcohol use, psychiatric symptoms, cognition, and other alcohol-related problems. Over 18 months, we offered the study to 111 patients, enrolled 47, and randomized 36; refusals were mainly due to stigma or patients' desire to handle problems on their own. Groups were similar at baseline, and 67% of patients met criteria for alcohol use disorder. Average patient satisfaction was high (mean = 28/32) regardless of group assignment. Sessions were delivered with 98% adherence to motivational interviewing principles and excellent motivational interviewing spirit; patients perceived the intervention to be more autonomy supportive than usual care. Group means after 6 months suggested that patients receiving the intervention might improve on measures such as alcohol use, psychiatric symptoms, legal problems, and days of paid work; however, they did not receive more substance use treatment. All results were nonsignificant due to small sample size.

Conclusions: A Recovery Navigator intervention was feasible and acceptable for delivering high-fidelity brief interventions to ICU patients. Changes in alcohol-related problems with motivational interviewing and shared decision-making were nonsignificant but clinically meaningful in size. A full-scale randomized trial of motivational interviewing and shared decision-making is warranted.
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October 2019

Screening, Brief Intervention, and Referral to Treatment: Nurses Helping Colorado Training Program.

J Nurs Educ 2018 Aug;57(8):476-482

Background: Nurses Helping Colorado was a Substance Abuse and Mental Health Administration-funded program to train nurses on Screening, Brief Intervention, and Referral to Treatment (SBIRT), a research-based strategy for preventing substance use disorders.

Method: Trainees were 678 undergraduate nursing students and 480 graduate advanced practice nursing students at an academic medical center. Training included classroom lectures, role-play simulation, and supervised practice. The program was evaluated using participant self-reports immediately posttraining, 3 to 12 months later, and postgraduation.

Results: Trainees reported high satisfaction, increased knowledge, and willingness to use SBIRT. Gains were maintained after training. After students graduated, 52% used screening, 52% offered brief interventions, and 37% used referral to treatment. Results were higher than those for past graduates, and most were higher than community benchmarks.

Conclusion: When SBIRT training was woven through nursing curricula, students demonstrated learning and used these methods in practice after graduation. SBIRT education is appropriate across the lifespan and across settings in nursing. [J Nurs Educ. 2018;57(8):476-482.].
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August 2018

Results From 10 Years of Interprofessional Training on Motivational Interviewing.

Eval Health Prof 2017 06 29;40(2):159-179. Epub 2016 Jun 29.

1 College of Nursing, University of Colorado, Aurora, CO, USA.

Motivational interviewing (MI) is a popular evidence-based method to support health behavior change. We examined evaluations from 10 years of interprofessional workshops on MI to identify trends in trainees' MI-related knowledge, attitude, and behavior. From 2006 to 2015, 394 trainees participated in continuing education MI workshops with our team and completed a validated posttraining questionnaire. Participants were 90% female and 66% White, with M = 12 years in practice. They worked in pediatric and adult care; urban and rural locations; and inpatient, outpatient, and nonhealth settings. The largest groups were nurses (20%), allied health professionals (20%), and health educators or case managers (15%). Trainees' professional diversity increased over time, their average age and years in practice decreased, and the percentage with prior MI training increased. Practitioners in telehealth and nonhealth settings had lower scores overall. Outcomes varied significantly by professional discipline: Mental health professionals, case managers, health educators, and nurses had higher scores on some outcome variables than nonhealth professionals. Years of clinical experience predicted MI-consistent attitude, but prior training, other demographic variables, and training process variations had no consistent effects. Although many trainees had already received MI training, outcome measures showed room for improvement. MI presents continued opportunities for interprofessional education.
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June 2017

Practical and analytic issues in the electronic assessment of adherence.

West J Nurs Res 2012 Aug 18;34(5):598-620. Epub 2011 Nov 18.

University of Colorado, College of Nursing, 13120 E. 19th Ave., Campus Box C288-04, Aurora, CO 80045, USA.

Although medication adherence can be measured many ways, researchers often view electronic dose monitoring devices like the Medication Event Monitoring Systems (MEMS) as more valid than patient self-reports. MEMS are popular but have potential problems. Based on the literature and MEMS data analyses, the authors suggest the following approaches: (a) a 1- to 2-month run-in should be used to reduce MEMS reactivity, (b) MEMS should be used with other measures of adherence, (c) adherence should be measured continuously, or a cutoff should be defined based on pharmacological properties of the medication and the consequences of nonadherence, (d) MEMS data usually should be aggregated weekly or monthly and evaluated using multilevel modeling, (e) MEMS-based screening for nonadherence may miss some patients in need of intervention, and (f) researchers should use strategies like training patients to use MEMS and purchasing extra MEMS caps to improve the completeness and accuracy of MEMS data.
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August 2012