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Computer-Based Training for Geriatric and End-of-Life Care in Prisons

Computer-Based Training for Geriatric and End-of-Life Care in Prisons

In a recent publication in the Journal of Correctional Health Care, authors from Penn State University, Indiana University, King’s College, and Klein Buendel share insights into the testing of a computer-based training for peer caregivers (PCs) in prisons to care for aged and dying prisoners. 

As the aged and dying incarcerated population increases, so does the demand on corrections health care. In the publication, the research team describes their process of conducting focus groups and performing usability testing with PCs and corrections staff members who ultimately helped identify the priority training topics.  

The focus groups, in consultation with an Expert Advisory Board, led to the creation of three prototype modules: Standard Precautions; Loss and Grief; and Role of the Inmate Caregiver in the Final Hours. Following the focus groups, face-to-face usability testing was conducted with PCs and staff who confirmed the contextual training relevance and feasibility of the computer-based training program. 

The team concluded that the computer-based training, Inmates Care, provides evidence to complement nurse-led training within the corrections setting with a standardized e-training package. A full description of the methods, results, discussion, strength and limitations, and conclusions can be found in the publication.  

This research was funded by a Phase I grant from the National Institute on Aging (AG057239). The project was led by Principal Investigator Dr. Susan Loeb from Penn State University and Co-Investigator Dr. Valerie Myers from Klein Buendel. Additional authors include Dr. Erin Kitt-Lewis from Penn State University, Tiffany Jerrod from Klein Buendel, Dr. Rachel Wion from Indiana University, and Dr. Julie Murphy from King’s College. 

E-Training to Enhance the Care of Aged and Dying Prisoners

E-Training to Enhance the Care of Aged and Dying Prisoners

The health care needs of aged, chronically ill, and dying inmates in correctional settings face growing demands. The Enhancing Care for the Aged and Dying in Prisons (ECAD-P) research team published insights from a geriatric care learning program for corrections staff as an abstract for the Annals of Behavioral Medicine. The ECAD-P research team is led by Dr. Susan Loeb from Penn State University and Dr. Valerie Myers from Klein Buendel. They would have presented the work at the 41st Annual Meeting and Scientific Sessions of the Society of Behavioral Medicine in San Francisco, had the conference been held as planned.

The number of older inmates in the United States continues to grow and best practices for managing geriatric issues and end-of-life (EOL) care have not been adapted for use in corrections settings. In response, ECAD-P team has developed a computer-based learning program for corrections staff comprised of six modules that address EOL and geriatric care concerns in prisons.

After conducting two rounds of usability testing at two prisons in different states, the ECAD-P program entered full-scale testing at seven state prisons. A total of 241 individuals consented to participate and 173 individuals completed all training modules and posttests. Outcomes revealed that the ECAD-P training program was acceptable, feasible, and usable in the corrections staff setting. The research team also found that corrections staff improved their knowledge of geriatric and EOL care of inmates overall after completing the training.

This research was funded by a Small Business Technology Transfer grant to Klein Buendel from the National Institute on Aging at the National Institutes of Health (AG049570; Dr. Susan Loeb and Dr. Valerie Myers, Multiple Principal Investigators). Collaborators and co-authors on this abstract also include Dr. Erin Kitt-Lewis from Penn State University; Dr. Rachel Wion from the Indiana University School of Nursing (formerly Penn State University); Julie Murphy from the King’s College Nursing Program; and Tiffany Jerrod, formerly of Klein Buendel.

Gaining Entry to Correctional Settings for Health Research

Gaining Entry to Correctional Settings for Health Research

In a recent publication for a special issue on Nursing Leadership in Correction in the journal Nursing Leadership, authors from Penn State University, Indiana University, King’s College, and Klein Buendel share lessons learned from implementing a large-scale health communication research project in correctional settings. The NIH-funded project developed, implemented, and evaluated computer-based learning modules to train corrections personnel in geriatric and end-of-life care for incarcerated individuals. The program, Enhancing Care for the Aged and Dying in Prison, was funded by a Small Business Technology Transfer (STTR) grant to Klein Buendel from the National Institute on Aging at the National Institutes of Health.

The lessons learned, and described in detail in the publication, include the importance of building a team of experts, “planning and punting” (such as designing a reliable communication plan and adjusting to the distinctive facets of each prison), coordinating with institutional review boards to protect vulnerable populations, and examining denied applications for access to correctional facilities in order to inform future planning. According to the authors, “These lessons serve to establish best practices on how to access correctional settings and to enable more research in corrections.” Access to even one correctional facility can help researchers learn more about and help to improve healthcare for people who are incarcerated.

This research was funded by a Phase I and II STTR grant from the National Institute on Aging (AG049570). The Phase I Multiple Principal Investigators were Dr. Janice Penrod and Dr. Susan Loeb from Penn State University. The Phase II Multiple Principal Investigators were Dr. Susan Loeb and Dr. Valerie Myers from Penn State University and Klein Buendel, respectively.  The first author of the recent Nursing Leadership publication is Dr. Erin Kitt-Lewis from Penn State University. Her coauthors include Dr. Susan Loeb from Penn State University, Dr. Valerie Myers and Tiffany Jerrod from Klein Buendel, Dr. Rachel Wion from Indiana University, and Dr. Julie Murphy from King’s College.

Lessons Learned: Accessing Sites for Correctional Research

Lessons Learned: Accessing Sites for Correctional Research

Dr. Erin Kitt-Lewis from Penn State University presented insights into accessing correctional facilities for research at the 32nd Annual Scientific Sessions virtual conference of the Eastern Nursing Research Society on March 26-27, 2020. Klein Buendel Senior Scientist, Dr. Valerie Myers, was a co-author on the presentation.

Despite the imperative to engage in research in corrections, researchers face many challenges due to the restrictive nature of this setting. Dr. Kitt-Lewis shared many of the lessons learned by this collaborative research team as they worked to secure diverse prison and jail settings to research, develop, and test the Enhancing Care for the Aged and Dying in Prison program.

Lessons learned included the discovery of contextually-specific constraints such as the closing or consolidating of services or facilities, managing staffing constraints, relocating staff, ascertaining and adhering to policies and administrative directives, and working within the guidelines of the review board of the correctional system.

Establishing and maintaining relationships with key stakeholders in corrections were also important aspects of this research. In her presentation, Dr. Kitt-Lewis discussed developing networking opportunities such as connecting via social media like LinkedIn, attending corrections conferences, and discussing potential research opportunities to help build relationships with key stakeholders and decision-makers. Additional perceptions from the field included identifying potential barriers or constraints to accessing correctional sites, and sustaining relationships post-research via ongoing communication such as sharing periodic updates, final reports, and publications with partners.

The correctional system has often been called a “closed” system due to the difficulty faced by researchers in attempting to access and conduct research. However, establishing well-defined strategies to conduct research in the system appears to create efficiency and promote much needed health-related research in the correction setting. Research outcomes that are contextually-specific can support and foster equitable care for people who are incarcerated.

This research was funded by a Small Business Technology Transfer grant to Klein Buendel from the National Institute on Aging at the National Institutes of Health (AG049570; Dr. Susan Loeb and Dr. Valerie Myers, Multiple Principal Investigators). Collaborators on the work presented, in addition to Dr. Erin Kitt-Lewis, include Dr. Susan Loeb and Kaléi Kowalchik from Penn State University; Dr. Rachel Wion from Indiana University School of Nursing; Julie Murphy from King College Nursing Program; and Dr. Valerie Myers and Tiffany Jerrod from Klein Buendel.

Computer-based Learning for End-of-Life Care in Prisons

Computer-based Learning for End-of-Life Care in Prisons

In a recent publication in the Journal of Forensic Nursing, authors from The Pennsylvania State University and Klein Buendel describe, in detail, the design and development of a computer-based learning program for geriatric and end-of-life (EOL) care for incarcerated people. The program, called Enhancing Care for the Aged and Dying in Prison (ECAD-P), was funded by a Small Business Technology Transfer (STTR) grant to Klein Buendel from the National Institute on Aging.

Content creation was based on the Phase I Principal Investigators’ paper-based EOL Toolkit. The systematic design and development of the training program was guided by the Institute for Healthcare Improvement’s Framework for Going to Full Scale. The Journal of Forensic Nursing paper describes the painstaking processes of designing a program logo, recording video testimonials, creating graphic novels, incorporating visually-stimulating images, confirming reading level, and programming the functionality of the media-rich, interactive computer-based training program. The final ECAD-P program has six modules which take approximately 2.5 hours to complete in one or more sessions.

The STTR Phase I and Phase II projects were funded by a grant from the National Institute on Aging (AG049570). The Phase I Multiple Principal Investigators, Dr. Janice Penrod and Dr. Susan Loeb, are from The Pennsylvania State University. The Phase II Multiple Principal Investigators, Dr. Susan Loeb and Dr. Valerie Myers, are from The Pennsylvania State University and Klein Buendel, respectively. Other paper coauthors include Rachel Wion from The Pennsylvania State University, Tiffany Jerrod from Klein Buendel, and Sophia Strickfaden from Johnson & Wales University. ECAD-P was programmed by the Creative Team at Klein Buendel.

Inmate Caregiver Training in Geriatrics and End-Of-Life

Inmate Caregiver Training in Geriatrics and End-Of-Life

Dr. Susan Loeb from Penn State University presented on the development of computer-based learning modules for caregivers of the aged and dying in prisons at the 31st Annual Scientific Sessions of the Eastern Nursing Research Society (ENRS) held in Providence, RI on April 3-5, 2019. This research is being conducted with Klein Buendel Senior Scientist, Dr. Valerie Myers, a co-author on the presentation.

More men and women are aging and facing end-of-life (EOL) while incarcerated. Early research by this research team found that computer-based training for inmates assisting staff in geriatric and EOL care was feasible. This collaborative team of nurse scientists, small business partners, and the correctional community are working to advance the quality of care provided for those aging and dying in our nations’ correctional institutions. Specifically, the purpose of the research presented at ENRS was to identify inmate peer caregiver training needs, and discover priority content areas and core values for inmate computer-based modules with the help of stakeholders and experts.

Six focus groups were conducted with stakeholders at one men’s and one women’s state correctional institution in a Mid-Atlantic state. Stakeholders included information technology and human resources staff, interdisciplinary front line staff who oversee inmate peer caregivers, and inmate peer caregivers. A content analysis identified content areas and core values. An Advisory Board of experts in EOL and geriatric care, corrections health, and corrections training, suggested combining some of the priority content areas. The resulting priority content areas for the initial Inmates Care modules were Universal Precautions, Role of the Inmate Caregiver in the Final Hours, and Loss and Grief. The core values identified for the inmates training were respect, dignity, and compassion. The next steps of the research project include completing three prototype modules, testing them for usability, and developing a specifications document for technology programming and production congruent with correctional facility security precautions.

This research was funded by a Small Business Technology Transfer (STTR) grant to Klein Buendel from the National Institute on Aging at the National Institutes of Health (AG057239; Dr. Susan Loeb, Principal Investigator) and Dr. Valerie Myers, Co-Investigator. Additional collaborators on the work presented at the conference include Dr. Erin Kitt-Lewis, Dr. Rachel Wion, and Julie Murphy from the Penn State University College of Nursing, and Tiffany Jerrod and Morgan Carter from Klein Buendel. The technology-based modules are being developed by the Creative Team at Klein Buendel.

Using E-Training to Enhance Geriatric and End-of-Life Care in Prisons

Using E-Training to Enhance Geriatric and End-of-Life Care in Prisons

Klein Buendel Senior Scientist, Dr. Valerie Myers, presented preliminary findings from a project that provides e-training of inmate peer caregivers to enhance geriatric and end-of-life (EOL) care in prisons at the 40th Annual Meeting and Scientific Sessions of the Society of Behavioral Medicine (SBM), March 6-9, 2019 in Washington, DC.

The United States has an incarceration rate of 655 people per 100,000, making it the highest globally. The older adult segment of the prison population has more than tripled since 1990 and their health issues are comparable to those of free people who are 10-15 years their senior. Inmates over the age of 55 have a death rate that is 10 times that of prisoners aged 25-34. United States prison systems are facing increased demands in caring for aged and dying inmates. A systematic review revealed that inmate peer caregivers can figure prominently in delivery of EOL care in prison. However, the degree of training received by inmate peer caregivers varies widely.

The lack of consistent training points to a need for evidence-based, current, and readily accessible training for this population to mitigate the growing need for EOL care in United States prisons. In response to this need, the E-training of Inmate Peer Caregivers for Enhancing Geriatric and End-of-Life Care in Prisons project, will demonstrate the scientific merit and feasibility of developing cutting edge, media-rich learning modules to train inmate peer caregivers in geriatric and EOL care. The aims of the project are to: (1) transform best practices in inmate peer caregiving into a comprehensive training program that consists of media-rich and highly interactive computer-based learning modules for providing geriatric and EOL care to their peers; and (2) conduct in-person usability testing of the media-rich and highly interactive web-based prototypes with inmates who are currently Mental Health Peer Support Specialists (that is, prisoners who are experienced caregivers, but naïve to geriatric and EOL care) and prison staff to evaluate the user interface, ease of use, and perceived barriers in order to refine and optimize the product.

Focus groups were conducted with three different groups, inmates, IT staff, and interdisciplinary staff, at a men’s and a women’s state correctional institution to inform content and program development of the training modules. Focus group participants prioritized the Universal Precautions, Loss/Grief, and Role of Inmate Caregivers in the Final Hours modules. These modules will be programmed and tested in state prisons in a mid-Atlantic state. The System Usability Scale, a validated tool for assessing the usability and acceptability of technological products, will serve as the primary outcome.

This research was funded by a Small Business Technology Transfer (STTR) grant to Klein Buendel from the National Institute on Aging at the National Institutes of Health (AG057239; Dr. Susan Loeb, Principal Investigator) and Dr. Valerie Myers, Co-Investigator. Additional collaborators on the work presented at the conference include Dr. Erin Kitt-Lewis, Dr. Rachel Wion, and Julie Murphy from the Penn State University College of Nursing, and Tiffany Jerrod and Morgan Carter from Klein Buendel. The technology-based modules are being developed by the Creative Team at Klein Buendel.

Development of Educational Modules to Enhance Care of Aged and Dying Inmates

Development of Educational Modules to Enhance Care of Aged and Dying Inmates

The United States has the highest rate of incarceration in the world and the demographics of the prison inmate population are shifting and aging. Many older adults are serving extended sentences and will age and die in place — making geriatric and end-of-life care an essential educational foci for prison staff. Consequently, resources are needed to adequately prepare prison staff to address this growing concern.

In a recent publication in Public Health Nursing, a research team led by Dr. Susan Loeb from Penn State University and including Klein Buendel (KB) Senior Scientist, Dr. Valerie Myers, reports on the development of educational modules to enhance the care of aged and dying inmates in prisons. The article describes the strategies used to “set-up” the Enhancing Care for the Aged and Dying in Prisons (ECAD-P) educational modules. “Set-up” is the first of four phases in the Institute for Healthcare Improvement (IHI) Framework for Going to Full Scale, which served as the conceptual framework for this study. Objectives achieved during the Set-up phase include: (a) establishing an approach for infusing the intervention into the target system; (b) identifying the product that needs scaling-up; and (c) determining what will be accomplished in the full-scale phase. Also, program buy-in within the given context and identification of the test sites, as well as support by early adopters, are essential.

The design approach for the educational modules included an environmental scan, a modified Delphi study, and a usability study.

An environmental scan provided a foundational understanding of the complex, contextual factors that impact correctional settings in the United States. Specifically, the environmental scan of diverse correctional settings helped to determine current educational approaches, education and learning preferences of personnel, and the technological capacity to deliver computer-based educational modules. Gaining knowledge was essential for the targeted development of modules that are tailored to address the health needs of the growing numbers of older inmates, many of whom will remain incarcerated through their end of life.

The Delphi process uses iterative group facilitation to forge reliable consensus on the opinion of experts through a series of structured questionnaires or rounds. The goal is to secure expert judgment based on experience. A Delphi survey was conducted early in the Set-Up phase to identify essential geriatric content for integration into the new prototype learning modules. The outcome was a reliable consensus on essential geriatric content for inclusion into the newly rebranded ECAD-P modules. An Expert Advisory Board reviewed the findings and validated the results.

For the usability assessment, the research team collaborated to design and program three media-rich, interactive computer-based prototype modules designed for the corrections context. The prototype, containing three modules, was built using Axure development software. The prototype was self-contained on a laptop computer. Each module had learning objectives, content delivered through multiple interactive features (for example: drag and drop, hover, click and reveal, video) and a final comprehension check quiz. Usability and acceptability testing were assessed following an established protocol examine navigability, detect problems, observe time spent solving problems, identify problem severity, and develop recovery strategies. After usability testing, the participants completed the System Usability Scale, a validated tool for assessing the usability and acceptability of technology-based products. Testing was conducted with 16 participants at two state correctional institutions in one mid-Atlantic state.

A full description of the methods, results, conclusions, and limitations of this study, as well as the implications for public health nursing, can be found in Public Health Nursing. This research was funded by a Small Business Technology Transfer (STTR) grant to KB from the National Institute on Aging at the National Institutes of Health (AG049570; Dr. Susan Loeb, Principal Investigator). Other collaborators/coauthors include Dr. Janice Penrod, Dr. Erin Kitt-Lewis, Dr. Rachel Wion, and Brenda Baney from Penn State University; and Sophia Strickfaden from Johnson & Wales University. KB’s Creative Team produced the ECAD-P prototype modules.

Developing Geriatric and End-of-Life E-training For Inmate Peer Caregivers

Developing Geriatric and End-of-Life E-training For Inmate Peer Caregivers

Dr. Susan Loeb from Penn State University presented on the development of computer-based learning modules for caregivers of the aged and dying in prisons at the 11th Annual Conference on the Science of Dissemination and Implementation in Health in Washington DC, December 3-5, 2018. This research is being conducted with Dr. Valerie Myers at Klein Buendel (KB), a co-author on the presentation.

The increasing numbers and complex needs of aged and dying inmates intensifies the burden of care and costs incurred by prisons. In an initial study (NR011874), best practices in the community were adapted in the Toolkit for Enhancing End-of-Life Care (EOL) in Prisons to train prison staff in EOL care. The print-based Toolkit was well received; however, not well suited for dissemination and lacked geriatric content. The Toolkit was transformed and expanded into Enhancing Care of the Aged and Dying in Prisons (ECAD-P) computer-based learning (CBL) modules in a second study (AG049570). ECAD-P development revealed the need to develop e-training for inmates to assist staff as caregivers for aged and dying inmates.

The purpose of the third study, which was presented at the D&I Conference, is to transform best practices in inmate peer caregiving into a comprehensive training program  that consists of media-rich and interactive computer-based learning modules for providing geriatric and EOL care to peers (i.e., prisoner to prisoner). Focus groups with inmate caregivers, prison staff, and training staff were conducted to determine a menu of CBL modules. An Advisory Board of experts in EOL care, geriatrics, ethics, and corrections health informed the selection of modules for development. Usability testing will soon be conducted in one men’s and one women’s prison with inmates who are experienced in providing mental health peer support, but have not been caregivers for their aged and dying peers. Focus group data will be analyzed using thematic analysis. Usability data will be analyzed using descriptive statistics and content analysis. Data are currently being collected. Analysis will be complete in October and the presentation completed by November.

The Prisoner to Prisoner (P2P) project allows the creation of innovative technology while being mindful of security and safety concerns regarding prisoners. Expanded testing of the P2P product will optimize the scalable unit for broader dissemination, establish the effectiveness of the training, provide critical insights relevant to dissemination of the commercial product, and position the research team to study broad dissemination and implementation outcomes.

This research was funded by a Small Business Technology Transfer (STTR) grant to KB from the National Institute on Aging at the National Institutes of Health (AG057239; Dr. Susan Loeb, Principal Investigator) and Dr. Valerie Myers, Co-Investigator. Additional collaborators on the work presented at the conference include Dr. Erin Kitt-Lewis and Dr. Rachel Wion from the Penn State University College of Nursing, and Tiffany Jerrod and Morgan Carter from KB. The technology is being developed by the KB Creative Team.

Insights on Computer-Based End-of-Life Training in Prisons

Insights on Computer-Based End-of-Life Training in Prisons

Dr. Valerie Myers, KB Senior Scientist and SBM Fellow, presented a poster on the Enhancing Care of the Aged and Dying in Prison project at the 39th Annual Meeting and Scientific Sessions of the Society of Behavioral Medicine (SBM), April 11-14, 2018 in New Orleans, Louisiana.

The prison population is aging at a rapid rate and is expected to continue to do so into the foreseeable future. As a result, prisons in the United States are facing increased demands in caring for aged, chronically ill, and dying inmates. Despite advances in the free world, best practices for managing geriatric issues and life-limiting or terminal illness have not been adapted for use in corrections settings. Implementing a training program addressing the health issues related to this population could mitigate legal risks and enhance care. However, the paramount focus on security makes technological advances available in the free word inaccessible inside prison walls.

Lessons learned from prior development, implementation, and evaluation research targeted at enhancing care for the aged and dying in prison led to the development of a media-rich interactive computer-based learning prototype, Enhancing Care of the Aged and Dying in Prison (ECAD-P). ECAD-P contains six modules that address end-of-life and geriatric care issues in prisons. The purpose of this aim of the project focused on a small-scale evaluation of ECAD-P. Specifically, in-person usability testing was conducted at one state department of corrections and one large city jail. Twelve participants evaluated the user interface, ease of use, and perceived barriers of the prototype, so that the research team may further understand user preferences, optimize the learning modules, and prepare for implementation.

A summary evaluation of the computer-based prototype training includes the participants’ impressions regarding the user interface of the computer-based training modules, beliefs about ease of use of the computer-based training modules, perceived barriers regarding the use of the computer-based training modules. Findings will be used to refine the computer-based training modules for large-scale usability testing targeting 12 prisons and jails across the United States. Lessons learned from this usability study and the larger scale usability study will inform future dissemination of the product. The intent of this educational product is to extend our reach to promote quality of health and health equity, as well as narrow the gap in health disparities experienced by a group that has often been described as “the least among us.”

This research project is funded by a grant from the National Institute on Aging (AG049570; Dr. Janice Penrod, Penn State University, Principal Investigator). Collaborators included Dr. Valerie Myers, Sophia Strickfaden, and Tiffany Jerrod from Klein Buendel, and Dr. Susan Loeb, Dr. Erin Kitt-Lewis, and Rachel Wion from the Penn State University College of Nursing.