Papers by Margeaux Chavez
Journal of Health Science and Education, Dec 31, 2019
Background: Using personal experience stories as teaching tools, clinical narratives are an effec... more Background: Using personal experience stories as teaching tools, clinical narratives are an effective means for sharing the art of nursing practice and provide insight into nurses' critical thinking and clinical proficiency. Using clinical narratives to assess curriculum effectiveness provides important insights into changed practice and learning beyond the classroom. Aim: This article provides an example of using clinical narratives in the evaluation of the Department of Veterans Health Affairs Office of Nursing Services (ONS) Evidence Based Practice Curriculum (EBPC). Methods: As part of a larger mixed-method evaluation of the EBPC, clinical narrative methods were employed to describe one incident where participants (n=3) applied at least two of three evidence based practice components (best available evidence; clinical expertise; patient preference). Results: Examination of clinical narratives demonstrated successful application of key components of evidence based practice and an integration into individual nursing practice beyond data obtained from other evaluation methods. Conclusions: Incorporating rich clinical narratives into a rigorous mixed-method program evaluation protocol provides insights beyond information uptake, satisfaction, efficacy, or competency assessment scores.
Journal of Medical Internet Research, Oct 6, 2016
for providing funding opportunities. Additionally, thank you to my committee members Dr. Christia... more for providing funding opportunities. Additionally, thank you to my committee members Dr. Christian Wells and Dr. Carol Bryant for their work on my thesis. Finally, a very special thank you goes to Susan Rheinhart, Academic Program Specialist in the Department of Anthropology for helping me keep track of all my important dates and paperwork. i TABLE OF CONTENTS List of Tables .
Journal of Wound Ostomy and Continence Nursing, 2019
Evidence suggests that inaccurate and incomplete pressure injury (PI) documentation threatens the... more Evidence suggests that inaccurate and incomplete pressure injury (PI) documentation threatens the validity of treatment and undermines policy and quality improvement. This quality improvement project sought to identify barriers and facilitators when conducting and documenting the daily comprehensive skin assessment in 31 Department of Veterans Affairs (VA) facilities. Evaluators in this 1-year, cross-sectional quality improvement project, using a qualitative approach, interviewed nurses of medical-surgical and critical care units. Participants (N = 62) from 12 high reassessment units (HRUs) and 13 low reassessment units (LRUs) were interviewed using telephone focus groups. Staff from HRUs reported 9 activities that ensured consistency in clinical practices, in validating data, and in correcting inaccuracies. The LRU staff tended to report performing only 2 of the 9 activities. The main barriers to accurate documentation were lack of knowledge, poor templates, and staffi ng issues such as understaffi ng and turnover, and main facilitators were an internal data validation process and a documentation template to local practices. Findings from this project led to increased VA leadership engagement, development of 3 innovative, award-winning VA mobile PI prevention and management applications, updated policies and directives on PI prevention, and upgrading of the national VA HAPI workgroup to an advisory committee and improved collaboration between the PI advisory committee and nursing informatics.
BACKGROUND Veterans Affairs Farming and Recovery Mental Health Services (VA FARMS) is an innovati... more 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.
Journal of veterans studies, Jul 15, 2016
Reintegration is known to be a difficult time for veterans. Peer support programs offer a good st... more Reintegration is known to be a difficult time for veterans. Peer support programs offer a good strategy for military and veterans, particularly as it relates to reintegration. We review an innovative, peer support program implemented at a veteran run community agricultural initiative (CAI). This project was a case-study evaluation using a mixed methods design including participant observations; qualitative interviews with a total of 34 CAI members and affiliates; and administered surveys to a total of 67 CAI members and affiliates. Survey results suggested that CAI participation contributed to improvements in communication, forming bonds, and developing new friendships with veterans, non-veterans, family members, and strangers, as well as increased involvement in community events. Interviews revealed that the CAI's informal peer-support culture and intentional normalization of sharing stories helped promote wellness and reintegration. The CAI continues to refine its peer support model. The organization is overcoming common barriers by leveraging community partnerships to bring veterans into the fold and expanding their peer support model to veteran organizations with similar missions. This approach will ultimately lead to a culture of peer support across agencies and spread the reach of the CAI's mission for veterans.
JMIR Research Protocols, Aug 19, 2022
Background Veteran community reintegration (CR) has been defined as participation in community li... more 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
Archives of Physical Medicine and Rehabilitation, Feb 1, 2018
To assess the effect of a veteran-oriented community agricultural initiative on transitioning rur... more To assess the effect of a veteran-oriented community agricultural initiative on transitioning rural veterans. Convergent mixed-method program evaluation. Veteran-oriented farm-to-market community agricultural initiative. Veterans (N=43) who were members of the community agricultural initiative. Health, well-being, and reintegration were assessed by self-reported data from interviews, a demographic survey, a validated health quality of life measure (Veterans RAND-12 [VR-12]), a validated reintegration measure (Military to Civilian Questionnaire), and a general satisfaction survey. Veteran participants were primarily white (88.4%, n=38) and men (74.4%, n=32), and most had a service-connected disability rating (58.2%, n=25). Qualitative and quantitative data revealed that the veterans participating in this community agricultural initiative experienced health and reintegration benefits. Results on the Military to Civilian Questionnaire, VR-12, and satisfaction survey suggest that participating in this community agricultural initiative contributed to improved mental, physical, and emotional health and vocational skills, community connectedness, and interpersonal communication. Qualitative interviews supported quantitative findings and revealed that participating in the community agricultural initiative provided veterans with a sense of satisfaction, a sense of belonging, and helped decrease the stigma surrounding their veteran status. Veterans who participate in this community agricultural initiative reported general improvements in physical and mental health, including improvements in sleep, nutrition, and exercise, and decreases in anxiety, pain, depression, and medication and substance use, all known factors which effect veteran reintegration.
JMIR Research Protocols, Feb 27, 2015
Background: The Department of Veterans Affairs (VA) has developed health information technologies... more Background: The Department of Veterans Affairs (VA) has developed health information technologies (HIT) and resources to improve veteran access to health care programs and services, and to support a patient-centered approach to health care delivery. To improve VA HIT access and meaningful use by veterans, it is necessary to understand their preferences for interacting with various HIT resources to accomplish health management related tasks and to exchange information. Objective: The objective of this paper was to describe a novel protocol for: (1) developing a HIT Digital Health Matrix Model; (2) conducting an Analytic Hierarchy Process called pairwise comparison to understand how and why veterans want to use electronic health resources to complete tasks related to health management; and (3) developing visual modeling simulations that depict veterans' preferences for using VA HIT to manage their health conditions and exchange health information. Methods: The study uses participatory research methods to understand how veterans prefer to use VA HIT to accomplish health management tasks within a given context, and how they would like to interact with HIT interfaces (eg, look, feel, and function) in the future. This study includes two rounds of veteran focus groups with self-administered surveys and visual modeling simulation techniques. This study will also convene an expert panel to assist in the development of a VA HIT Digital Health Matrix Model, so that both expert panel members and veteran participants can complete an Analytic Hierarchy Process, pairwise comparisons to evaluate and rank the applicability of electronic health resources for a series of health management tasks. Results: This protocol describes the iterative, participatory, and patient-centered process for: (1) developing a VA HIT Digital Health Matrix Model that outlines current VA patient-facing platforms available to veterans, describing their features and relevant contexts for use; and (2) developing visual model simulations based on direct veteran feedback that depict patient preferences for enhancing the synchronization, integration, and standardization of VA patient-facing platforms. Focus group topics include current uses, preferences, facilitators, and barriers to using electronic health resources; recommendations for synchronizing, integrating, and standardizing VA HIT; and preferences on data sharing and delegation within the VA system. Conclusions: This work highlights the practical, technological, and personal factors that facilitate and inhibit use of current VA HIT, and informs an integrated system redesign. The Digital Health Matrix Model and visual modeling simulations use knowledge of veteran preferences and experiences to directly inform enhancements to VA HIT and provide a more holistic and integrated user experience. These efforts are designed to support the adoption and sustained use of VA HIT to support patient self-management and clinical care coordination in ways that are directly aligned with veteran preferences.
Workplace Health & Safety
Background: Assisted falls occur when staff try to minimize the impact of falls by slowing a pati... more 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 ave...
JMIR Research Protocols
Background Veterans Affairs Farming and Recovery Mental Health Services (VA FARMS) is an innovati... more 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...
BMC Health Services Research, Nov 5, 2022
Objectives: The Veterans Administration (VA) Mobility Screening and Solutions Tool (VA MSST) was ... more Objectives: The Veterans Administration (VA) Mobility Screening and Solutions Tool (VA MSST) was developed to screen a patient's safe mobility level 'in the moment' and provide clinical decision support related to the use of safe patient handling and mobility (SPHM) equipment. This evidence-based flowchart tool is a common language tool that enables any healthcare worker at any time to accurately measure and communicate patient mobility and transfer equipment needs across disciplines and settings. Methods: The VA MSST has four levels and differentiates between the need for powered and non-powered equipment depending on the patient's independence. Subject matter experts wrote scenarios for interrater reliability and validity testing. The initial VA MSST draft iteration was reviewed by 163 VA staff (mostly physical therapists and occupational therapists) amongst simulation scenarios and provided content validity, and additional insight and suggestions. Revisions were made to create the final VA MSST which was evaluated by over 200 healthcare workers from varied disciplines (including medical doctors, advanced practice registered nurses, registered nurses, licensed practical nurses, certified nursing assistants, occupational therapists, physical therapists, speech therapists, radiology and ultrasound technicians, etc.). An instruction video and eighteen scenario videos were embedded in an online survey. The survey intended to demonstrate the interrater reliability and validity (concurrent and construct) of the VA MSST. Over 500 VA staff (raters) received a survey invitation via email. Results: Raters (N = 230) from multiple disciplines and healthcare settings independently screened patient mobility status for each of 18 scenarios using the VA MSST. The raters were diverse in their age and years of experience. The estimated interrater reliability (IRR) for VA MSST was excellent and statistically significant with an estimated Krippendorff's alpha (ICC (C, k)) of 0.998 [95% CI: 0.996-0.999]. Eighty-two percent of raters reported that overall VA MSST instructions were clear or very clear and understandable. VA MSST ratings made by technicians and nursing assistants group correlated strongly (r = 0.99, p < 0.001) with the 'gold standard' (experienced physical therapists), suggesting a high concurrent validity of the tool. The VA MSST significantly discriminated between the different levels of patient mobility required for safe mobilization as intended (each difference, p < 0.0001); this suggests a good construct validity.
Journal of Veterans Studies
Veteran communities including veterans, their families, and their caregivers are vital collaborat... more 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&amp;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 innovati... more 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 Affa...
JMIR Research Protocols, 2015
Background: The Department of Veterans Affairs (VA) has developed health information technologies... more Background: The Department of Veterans Affairs (VA) has developed health information technologies (HIT) and resources to improve veteran access to health care programs and services, and to support a patient-centered approach to health care delivery. To improve VA HIT access and meaningful use by veterans, it is necessary to understand their preferences for interacting with various HIT resources to accomplish health management related tasks and to exchange information. Objective: The objective of this paper was to describe a novel protocol for: (1) developing a HIT Digital Health Matrix Model; (2) conducting an Analytic Hierarchy Process called pairwise comparison to understand how and why veterans want to use electronic health resources to complete tasks related to health management; and (3) developing visual modeling simulations that depict veterans' preferences for using VA HIT to manage their health conditions and exchange health information. Methods: The study uses participatory research methods to understand how veterans prefer to use VA HIT to accomplish health management tasks within a given context, and how they would like to interact with HIT interfaces (eg, look, feel, and function) in the future. This study includes two rounds of veteran focus groups with self-administered surveys and visual modeling simulation techniques. This study will also convene an expert panel to assist in the development of a VA HIT Digital Health Matrix Model, so that both expert panel members and veteran participants can complete an Analytic Hierarchy Process, pairwise comparisons to evaluate and rank the applicability of electronic health resources for a series of health management tasks. Results: This protocol describes the iterative, participatory, and patient-centered process for: (1) developing a VA HIT Digital Health Matrix Model that outlines current VA patient-facing platforms available to veterans, describing their features and relevant contexts for use; and (2) developing visual model simulations based on direct veteran feedback that depict patient preferences for enhancing the synchronization, integration, and standardization of VA patient-facing platforms. Focus group topics include current uses, preferences, facilitators, and barriers to using electronic health resources; recommendations for synchronizing, integrating, and standardizing VA HIT; and preferences on data sharing and delegation within the VA system. Conclusions: This work highlights the practical, technological, and personal factors that facilitate and inhibit use of current VA HIT, and informs an integrated system redesign. The Digital Health Matrix Model and visual modeling simulations use knowledge of veteran preferences and experiences to directly inform enhancements to VA HIT and provide a more holistic and integrated user experience. These efforts are designed to support the adoption and sustained use of VA HIT to support patient self-management and clinical care coordination in ways that are directly aligned with veteran preferences.
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Papers by Margeaux Chavez