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Educational Campaign: Using Exercise to Prevent Postpartum Depression
Full text linkPostpartum depression is one of the most common medical ailments surrounding childbirth. It affects up to 20% of postpartum women and has detrimental effects not only on the mother but her infant and family as well (Navas et al., 2021). Currently, the medical community takes a reactive approach to postpartum depression by screening and treating cases of postpartum depression as they occur. An evidence-based search of peer-reviewed articles found that exercise in the perinatal period had a positive effect on maternal mental health and decreased postpartum depression scores. This is especially true for women who have a history of depression or are currently experiencing postpartum depression. Although all types of exercise have been found to decrease postpartum depression, the most significant change occurred when women completed moderate-level aerobic activities for at least 150 minutes/week (Pritchett et al., 2017).
Instead of being primarily reactive when it comes to postpartum depression, the medical community should be proactive by educating perinatal women that exercise can decrease their chances of developing postpartum depression. This paper discusses a low-cost educational campaign designed as a benchmark project. The educational campaign consists of a flyer, brochure, video, and changes to discharge paperwork. The timeframe from the start of the project to disseminating information to patients would take approximately 20 weeks and includes gaining managerial support, creating the educational material, and educating staff.
The Edinburg Postnatal Depression Scale (EPDS) and a two-question survey will be used to evaluate the effectiveness of this educational campaign
Evidence-Based Practice - Oral Mucositis Prevention in Chemotherapy Patients: A Benchmark Project
Full text linkThe purpose of this implementation project is to help decrease the rates of mucosal barrier injuries (MBI’s) and oral mucositis (OM) in patients receiving chemotherapy on the oncology unit. In 2022, it was reported that seven MBI’s occurred on an oncology unit in a large county hospital in an urban area. This secondary infection has the potential to increase morbidity, increase treatment costs, lengthen hospital stays, and can have a devastating impact on quality of life (Correa et al., 2019). There is currently no protocol in place at the proposed location for this intervention that will help reduce this potential side effect of chemotherapy. If a secondary infection occurs during admission, the hospital is responsible for the cost. The lack of a preventative protocol created interest for multiple stakeholders. Research shows that an evidence-based oral care protocol should be implemented to help prevent this secondary infection. The intervention chosen not only had to be effective, easily available, low cost, but also needed to be easily performed.
According to research, the best way to prevent MBI’s and OM is to create an oral care protocol that simply includes brushing teeth and using a mild oral rinse twice a day. Prior to the trial period, education will need to be completed for all staff on proper oral assessments, proper documentation for tracking purposes, and patient education. This proposed project will take an interdisciplinary team to accomplish with all hospital stakeholders involved
Reducing Central Line-Associated Bloodstream Infections (CLABSI) with Chlorhexidine-Impregnated Dressings
Full text linkMitigating and eradicating central line-associated bloodstream infections (CLABSI) is a vital patient safety priority. These healthcare-associated infections lead to patient fatalities and incur costly, preventable expenses. Therefore, it is imperative to assess central venous catheter (CVC) maintenance protocols to mitigate the likelihood of infection. Federal guidelines advocate using chlorhexidine (CHG) dressings to lower this risk (Centers for Disease Control and Prevention, 2017). A comprehensive central line maintenance bundle includes incorporating a CHG dressing as a critical measure in reducing the risk of CLABSI (Buetti et al., 2022). Consequently, the escalating infection rates underscore the necessity for implementing CHG dressings (Buetti et al., 2022).
Currently, two CHG-based CVC dressings, namely the CHG gel and disk dressings, are commercially accessible. This project aims to deploy CHG gel dressings for patients necessitating CVCs admitted to units with a documented history of elevated rates of CLABSI. The anticipated outcome of introducing the CHG gel dressings is reducing CLABSI incidence rates. This project aims to show this distinct reduction in CLABSI rates in a twelve-week time frame. This intervention presents a straightforward yet highly efficient solution with the anticipated outcome of reducing the incidence of CLABSIs
Clinician Education Program: Promoting the Use of Care Bundles in Reducing the Hospital Length of Stay and Readmission Rates of Adult COPD Patients
Full text linkManagement of COPD patients can cost hospitals approximately 7,500 and estimated daily expenses of 3,760 (Hegwer, 2018). With a substantial reduction in LOS and RAR, the organization can save 3,656,904 for the first fiscal year. Other advantages are improved patient outcomes, better patient satisfaction ratings, efficient resource allocation, and improved quality care (Atwood et al., 2022)
Modality and terminology changes for behavioral health service delivery during the COVID-19 pandemic: a systematic review
Full text linkIntroduction: The COVID-19 pandemic prompted healthcare professionals to implement service delivery adaptations to remain in compliance with safety regulations. Though many adaptations in service delivery were reported throughout the literature, a wide variety of terminology and definitions were used. Methods: To address this, we conducted a PRISMA review to identify service delivery adaptations across behavioral healthcare services in the United States from March 2020 to May 2022 and to identify variations in terminology used to describe these adaptations. We identified 445 initial articles for our review across eight databases using predetermined keywords. Using a two-round screening process, authors used a team approach to identify the most appropriate articles for this review. Results: Our results suggested that a total of 14 different terms were used to describe service modality changes, with the most frequent term being telehealth (63%). Each term found in our review and the frequency of use across identified articles is described in detail. Discussion: Implications of this review such as understanding modality changes during the COVID-19 pandemic and beyond are discussed. Our findings illustrate the importance of standardizing terminology to enhance communication and understanding among professionals
The Labor Market: Where Did Workers Go?
No full textThe Hibbs Institute\u27s March 2024 Hibbs Outlook of East Texas report, titled The Labor Market: Where Did Workers Go? , examines the labor shortages in the United States, with a particular focus on East Texas. The report highlights that the COVID-19 pandemic led to a significant economic recession, resulting in the loss of nearly 22 million jobs and an unemployment rate spike from 3.5% in February 2020 to 14.8% in April 2020. Subsequent government interventions, including the CARES Act and reduced federal interest rates, facilitated a rapid recovery, with employment levels surpassing pre-pandemic figures by June 2022. Despite this recovery, a labor shortage emerged by mid-2021, characterized by job openings exceeding the number of available workers. In East Texas, this shortage became evident in 2019, intensified during the pandemic, and peaked in April 2022 with approximately 2.02 job openings per unemployed individual. The report attributes these shortages to factors such as early retirements, increased childcare costs, alternative income sources, and skill mismatches, emphasizing the need for strategic policies to address ongoing labor market imbalances
A Framework for a New Paradigm of Opioid Drug Tapering Using Adjunct Drugs
Full text linkThe misuse of and dependency on prescription opioids represents a significant crisis at the national level, impacting not only the health of the public but also the societal and economic well-being. There is a critical need for strategies to reduce the dosage of prescribed opioids to limit opioid-associated adverse effects and lower the risk of addiction development in patients experiencing chronic pain. Opioid-sparing medications, when co-administered with opioids, enable a reduced opioid dose without loss of efficacy.This suggests the potential for using opioid adjunct drugs in opioid tapering, whereby opioid doses are lowered incrementally in a systematic manner to improve a patient’s safety profile or quality of life. The objective of this report is two-fold: 1) to illustrate the potential for adjunct drugs in opioid tapering, and 2) to describe the steps needed to be taken to develop a framework for the use of adjunct drugs in opioid tapering. This can provide the impetus for further investigation into opioid tapering and the development of improved clinical care. The proposed project implements knowledge synthesis methods to develop the framework for a new paradigm of opioid drug tapering that incorporates opioid dosage reductions with adjunct drugs. Framework development is organized into three major phases: 1) Adjunct drug characterization, 2) Assessment of the opioid-sparing effect, and 3) Usability of data for clinicians. The knowledge gained from this project can provide a foundation for improved analgesia protocols for opioids and adjunctive drug therapy
Discharge Preparedness for the Type 1 Diabetic Patient
Full text linkThe purpose of this paper is to highlight the individual who suffers from type 1 diabetes, because there appears to be a disparity in the equity of their healthcare needs as compared to other chronic illness. Type 1 diabetes is a progressive illness that places a tremendous burden on the person inflicted with it, including emotional, physical, and financial strains, and these burdens contribute to an emotional condition known as diabetic distress (Orben et al., 2022). This distress impacts the individual’s self-efficacy, and they see more frequent exacerbations of their diabetes like diabetic ketoacidosis (DKA) (Fisher et al., 2018; Hood et al. 2018; Orben et al., 2022). The cost of insulin is high but the cost of a hospitalization with a diagnosis of DKA on average costs the individual $30,000 (Lyerla et al., 2021).
An evidence-based approach to improving this healthcare inequity for the type 1 diabetic is to provide a text-based intervention that educates, encourages self-efficacy, and empowers the type 1 diabetic patient to take ownership of their disease process. The evidence-based practice question that guided my search through the literature is as follows: In young adults with type 1 diabetes discharged to home following a post diabetic ketoacidosis (DKA) episode, how does diabetes discharge instructions with a follow up educational text message at 48 hours and at 2 weeks after discharge, compare to diabetes discharge instructions without a follow up educational text message affect the rate of rehospitalizations with recurrent DKA within 3 months after intervention?
The plan is to implement this project that utilizes a text-based intervention to recently discharged type 1 diabetic patients. Each case will be evaluated over a three-month span of time after discharge. The desired outcome and aim are that there be no additional hospitalizations following the patient’s initial hospitalization for DKA for those who received the intervention
The Impact of Kangaroo Care on Exclusive Breastfeeding in Premature Infants
Full text linkThis benchmark project emphasizes the crucial imperative of promoting exclusive breastfeeding among preterm and low birth weight infants in neonatal intensive care units (NICUs). Despite the well-documented benefits, exclusive breastfeeding rates remain disappointingly low. This evidence-based project focuses on early intervention through kangaroo care to bolster exclusive breastfeeding rates, with the overarching aim of enhancing infant outcomes and mitigating risks of mortality and morbidity. Engaging key stakeholders, including NICU leadership, nursing staff, lactation consultants, and families, is paramount for the successful implementation of the program. The project presents a detailed implementation plan encompassing various phases, from admission procedures to sustainability measures. Key components include comprehensive information dissemination to families upon admission, introductory sessions conducted by lactation consultants, and collaboration between registered nurses and lactation consultants to facilitate kangaroo care sessions. The program also outlines an infant protocol to ensure the safety and eligibility of infants for kangaroo care. Data collection methods, including chart reviews, surveys, and in-depth interviews, are employed to evaluate breastfeeding outcomes, kangaroo care sessions, and parental satisfaction. Although presented as a benchmark initiative, discussion delves into potential challenges and considerations in implementation. Leadership strategy, innovation, sustainability, and change management are highlighted as critical elements for success
BRAIN MATTERS: COGNITIVE-BEHAVIORAL THERAPY AND ANTIDEPRESSANTS FOR POST-STROKE DEPRESSION
Full text linkStroke is the leading cause of death and disability in the United States, and approximately one-third of these patients will develop post-stroke depression, which is associated with higher rates of morbidity and mortality (American Stroke Association, 2022). Even though post-stroke depression is prevalent, it often goes undertreated. The combination of antidepressants and cognitive-behavioral therapy has shown to be an effective method of treating post-stroke depression. There are cognitive-behavioral exercises that nurses can implement, such as group therapy, acceptance therapy, and cognitive retraining, a method of coaching the patient to replace negative thoughts with positive ones (Byun et al., 2021). With the addition of antidepressants prescribed by advanced practice practitioners or physicians, the patients can receive combination therapy. The consequences of not treating post-stroke depression include significant increases in hospitalization costs, poor patient outcomes, and increased length of stay (Lavu et al., 2022; American Stroke Association, 2022). The combination of antidepressants with cognitive-behavioral therapies versus singular treatment with antidepressants alone has shown to be effective in decreasing post-stroke depression symptoms and therefore should be considered as first-line treatment (Starkstein & Hayhow, 2019).To address the problem of post-stroke depression, the following research question was developed: In post-stroke patients who develop depression, how effective is cognitive-behavioral therapy combined with antidepressants, compared to antidepressants alone, in treating post-stroke depression symptoms, within the first three months post-stroke