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Multi-objective genetic algorithm based energy management system considering optimal utilization of grid and degradation of battery storage in microgrid
Get PDFThis paper develops intelligent energy management in Microgrid using forecasting-based multi-objective optimization using genetic algorithm framework. In this work, the energy storage system is included in Microgrid network, which is essential for effective energy management and smooth power transfer. The developed model incorporates the forecasted values of solar PV and wind generation obtained using time series long short-term memory network for the next 24 h and provides the optimal values of battery and grid powers to meet the deficit of power to meet the demand in the Microgrid. The proposed model incorporates grid power consumption cost and battery degradation cost as the objectives with battery status and renewables utilization as the constraints of the optimization model. The fuzzy decision-making strategy obtains the compromise solution in the Pareto optimal front from multiple solutions. The proposed model is investigated with fixed and variable grid tariff conditions achieving efficient performance in energy management with optimal utilization of renewables, grid and battery in the system for 24 hours-time horizons. The system parameters in the Microgrid network are also investigated in the time horizon with the optimal values of proposed model. The proposed intelligent energy management system model is tested in 2.5 MW PV/wind/energy storage Microgrid system in MATLAB 2020 simulation platform and experimental setup of 1 kW grid connected Microgrid with solar PV and battery
THE PERCEPTIONS OF PEOPLE WITH DEMENTIA, CARE PARTNERS, CNAs/SITTERS, AND PROVIDERS DURING THE COVID-19 PANDEMIC UP TO NOW: A MULTIPLE CASE STUDY
Get PDFThe perceptions of people with dementia, care partners, CNAs/sitters, and providers during the COVID-19 pandemic until now can be useful in formulating better ways to care for people with dementia in future disasters or pandemics. The study explored the perceptions of people with dementia, care partners, CNAs/sitters, and providers during the COVID-19 pandemic, from onset until now, to help formulate better ways to care for people with dementia during a pandemic or disaster. Algase’s Need-driven Dementia-compromised Behavior Model guided this comparative, multiple-case study. Six people with dementia, six care partners, five CNAs and one sitter, and six providers were interviewed to gather their perceptions during the COVID-19 pandemic up to now. Findings supported theoretical propositions the four proximal factors: unmet physiological and psychosocial needs and changes in the physical and social environments led to behavioral and psychological symptoms of dementia and might have contributed to care partner burnout. The Need-driven Dementia-compromised Behavior Model provides a foundation for identifying the needs of people with dementia, future research, practice and policy changes during a health or natural disaster
Handedness and test anxiety: An examination of mixed-handed and consistent-handed students
Get PDFTest anxiety refers to maladaptive cognitive and physiological reactions that interfere with optimal performance. Self-regulatory models suggest test anxiety occurs when there is a perceived discrepancy between current functioning and mental representations of desired academic goals. Interestingly, prior investigations have demonstrated those with greater interhemispheric communication are better able to detect discrepancies between current functioning and preexisting mental representations. Thus, the current study was designed to investigate the relationship between test anxiety and handedness—a commonly used proxy variable for interhemispheric communication. Undergraduate and graduate students (N = 277, 85.20% female, 68.19% Caucasian, age = 29.88) (SD = 9.53) completed the FRIEDBEN Test Anxiety Scale and Edinburgh Handedness Inventory – Short Form. A series of Mann–Whitney U tests were used to test for differences in the cognitive, physiological, and social components of test anxiety between mixed- and consistent-handers. The results indicated that mixed-handers had significantly higher levels of cognitive test anxiety than consistent-handers. We believe this information has important implications for our understanding of the role of discrepancy detection and interhemispheric communication in eliciting and maintaining test-anxious responses
Implementation of an Evidence-Base Hospital Acquired Pressure Injury Prevention Program
Get PDFCovid-19 hindered many quality improvement projects. As the stressors from the pandemic began to disappear the healthcare industry was struck with new struggles. These new struggles were ensuring quality care was being provided to all patients. The decline in quality care also led to a decline in reimbursement from payor sources, such as Medicare. During the pandemic the healthcare industry was at their most vulnerable state and now that the dust is settling the ramifications of just surviving are staring the industry right in the eyes. Change is difficult, but it is even more difficult following traumatic events such as the pandemic.
In order to effectively initiate change the project leader must ensure they gather all information before presenting to the team. In creation of a pressure ulcer prevention bundle (PUPB) to decrease the hospital-acquired pressure injury (HAPI) rates the project leader must understand where the problem lies before initiating change. Once the problem is identified the leader must find evidence-based practices (EBP) that will support the proposed change. In order to help change be successful the staff must understand why the change is needed and they must be included to the change process. By including the end-user in the change process the leader is ensuring compliance in the long run. Since patients are the heart of the healthcare industry it is important the nursing staff is able to confidently provide education to them in regards to why these measures are so important for them to be compliant with.
As with any change continuity and auditing is important. The project leader must continually work to ensure the change process is still working and if it is not communicate with the bedside staff to understand the why it is no longer working. The most important aspect when starting any change project is ensuring the key stakeholders are identified and everyone works together as a team
Shift Change: Minimizing the COVID-19 Nursing Shortage and Decreasing Nursing Burnout
Get PDFBurnout and the nursing shortage of the healthcare system is not a new issue for nurses, but the COVID-19 pandemic caused this problem to only get worse (Young, 2021). Most healthcare facilities are severely understaffed. The nursing shortage and symptoms of burnout among nurses working in the Intensive Care Units (ICU) and other high-demand COVID-19 nursing units have been magnified by the COVID-19 pandemic. Inferior working conditions such as increased work times, increased workload, and decreased training in the care of COVID-19 patients magnified nursing burnout and the ongoing nursing shortage (Galanis et al., 2021). Discovering ways to reduce the stress and burnout of the nurses working the frontlines of the pandemic is critical to promoting positive mental health of nurses. Some studies have shown there is a correlation between nursing satisfaction and the shift hours worked. Adverse effects such as stress and burnout of nurses, decreased patient outcomes, and lower patient satisfaction reports are associated with nurses working longer hours (Hoedl et al., 2021). The 2023 National Council of State Boards of Nursing (NCSBN) reported that approximately 100,000 Registered Nurses (RNs) left the workforce because of burnout, stress, or retirement during the COVID-19 pandemic.
A change is needed to address the ongoing nursing shortage. A prudent, manageable, and cost-efficient way to help reduce nursing burnout is by decreasing the nursing shifts from twelve-hour to eight-hour shifts on high-stress and high- demand nursing units. The PICOT question that will be used for the evidence-based change is the following: In ICU nurses taking care of COVID-19 patients (P), how do eight-hour shifts (I) compared to twelve-hour shifts (C) affect nursing burnout (O) within eight weeks (T)
Role of Hand Hygiene in the Prevention of Central Line-Associated Bloodstream Infection in Intensive Care Unit Patients: A Benchmark Project
Get PDFCLABSI (Central Line Associated Blood Stream Infection) is one of the most common hospital-acquired infections in the ICUs (Intensive Care Unit). Not only it is cost prohibitive, but it also prolongs hospitalization. However, it is avoidable. This condition needs to be reviewed to improve patients’ outcomes in the ICUs. This project aims to decrease or eliminate the incidence of CLABSI among ICU patients through proper and mindful hand hygiene. Healthcare providers should be aware of the different care bundles that contribute to decreasing CLABSI and be able to apply them correctly. Articles were searched on different databases such as Cochrane Library, PubMed, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). This paper is written to help healthcare providers in taking extra steps to eliminate CLABSI. Proper hand hygiene before accessing and manipulating central lines can lead to zero CLABSI
Continuity of Care in the Post-Partum Period
Get PDFMaternal mortality rates in the United States have been a growing concern over the past decade, with rates continuing to climb as recent studies have been published. The total maternal mortality rate in the United States in 2018 was 17.4 and has increased to 32.9 as of 2021, while other developed countries continue to decline (Hoyert, 2023). The maternal mortality rate is the number of deaths per 100,000 live births. More than 50% of pregnancy-related deaths in the United States occur after delivery, in the post-partum period (Melillo, 2020). The purpose of this report is to not only bring light to this nationwide health crisis, but to test solutions to that will fill the gap between our postpartum mothers and the high-quality care that should be available and provided to all.
The change project in this report addresses continuity of care in the postpartum period. Specifically, post-partum follow up recommendations for mothers diagnosed with a hypertensive disorder of pregnancy and mothers who screen positive on their post-partum depression screen prior to discharge. The American College of Obstetrician and Gynecologists (ACOG), recommends that women who experience any hypertensive diagnosis in pregnancy, should follow up for a blood pressure visit no later than 7-10 days after discharge (2018). ACOG also recommends that mothers who experience a severe hypertensive episode during their admission, should follow up for a blood pressure visit no later than 2-3 days post discharge. Appointments will also be scheduled with a local psychiatric mental health nurse practitioner, PMHNP, within 2 weeks of discharge for mothers who screen positive on their Edinburgh Postnatal Depression Scale, EPDS. These efforts are focused on improving continuity of care in the postpartum period and decreasing maternal morbidity and mortality cases related to hypertension and mental health disorders. Improving quality of care in the postpartum period should also reveal a decrease in postpartum readmissions.
In review of data collected during the 6-week project period, it is evident that tailoring post-partum visits to the specific needs of postpartum patients is a successful and proactive approach to improving outcomes for this population. During these visits, if findings weren’t within expected limits, providers were able to either initiate treatment or alter treatment for hypertensive patients and patients with mental health disorders. Although findings revealed improved continuity of care, there needs to be a larger population and more time spent to determine if these interventions will decrease the maternal mortality and morbidity rates
Making Breastfeeding Easier with Clinician Support
Get PDFThis benchmark project provides a template for how to implement clinician support and education in an organization with obstetric and pediatric clinics and a hospital based on the PICOT: In first-time breastfeeding mothers (P), how does clinician driven support and education during the perinatal period (I) compared to no clinician assistance (C) affect the rate of continued breastfeeding (O) within the first 3 months postpartum (T). Research demonstrates that increased clinician support and education provided to the mothers during the perinatal period increases breastfeeding rates and self-efficacy. The project would initially last for approximately 12 weeks and follow women from their last few antepartum appointments through their child\u27s 3 month well child check. This project has not been implemented at time of publication and no results are available
Standards of Care in Surgical Site Prevention Benchmark Study
Get PDFIn depth synthesis of studies supporting efficacy of alcohol-based rubs in prevention of surgical site infections
Postpartum Education on Maternal Morbidity and Mortality
Get PDFPostpartum education, or lack thereof, is the most overlooked cause of maternal morbidity and mortality. The lack of thorough postpartum education with patient understanding is often the reason warning signs are overlooked as normal and seeking care is delayed, or not pursued at all. This narrative review aims to find research to enhance awareness of maternal morbidity/mortality and improve patient outcomes through education, including ways to intervene beforehand. The literature review began in August 2021, suitable peer-reviewed studies were retrieved from CINAHL, Cochrane, and PubMed databases. Evidence from the reviewed studies found supporting evidence indicating insufficient postpartum education related to the lack of education/cultural differences with patients, communication barriers when providing instruction, understanding emergency situations, and identifying warning signs were the most common contributors to poor outcomes. The review of studies did not specify the duration of postpartum education or ways that education was presented. The search yielded twelve studies that were found with main keywords, maternal morbidity, maternal mortality, and postpartum education. Future research should determine if postpartum education throughout pregnancy will help mothers retain the vast amount of emergency information over time, rather than a fifteen-to-twenty-minute timeframe at hospital discharge. Training through information and skills assessment for nurses to ensure they are knowledgeable and confident in their teachings, along with patient follow-up calls between visits, will also provide a great service to this population