2313 research outputs found
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An Evidenced Based Proposal to Increase Advanced Directive Completion in the Outpatient Setting
No full textClinical Problem: Despite the research indicating the positive outcome of advanced care planning (ACP), completion rates of advanced directives remain overall only around 25% (Ma et al., 2020). Outpatient primary care provides an ideal setting for advanced care planning discussions to promote advanced directive completion, yet barriers continue to exist.
Significance: When health-care delivery is in line with the patients’ values and goals of care at the end of life it increases patient and family satisfaction and empowerment, enhances comfort and dignity, prevents unnecessary intervention and suffering, and decreases hospital costs. Delayed discussions with patients and family members lead to increased instances of psychological and emotional distress when faced with the burden of having these conversations in an acute setting with unknown providers (Ma et al., 2020). Advanced care planning and goals of care (GOC) discussions aimed to complete advance directives (ADs) are a way in which the patient and provider can ensure that care delivery at the end of life is in accordance with these values.
PICOT Question: The purpose of this evidence-based proposal will be to examine and explore the implementation of the PREPARE program in the completion of advanced directives. “In patients, greater than 65 years old will the PREPARE program increase the likelihood of advanced directive completion?”
Clinical Change: The proposed clinical change is to implement the PREPARE program in an outpatient primary office to increase advanced care planning discussions and the completion of advanced directives.
Desired Outcome: The desired outcome for the implementation of the proposed clinical change is an increase in advanced care planning and the completion of advanced directives in the outpatient setting in patients 65 years and older.
Summary: An outline for implementation of the PREPARE program in an outpatient primary care office was described, and contextual factors, systems focus, budgets, and return on investments were evaluated to promote the feasibility of the project. The given proposal has provided a detailed plan and highlighted the benefit of the implementation of the PREPARE program in the outpatient primary care office, to improve patient-centered outcomes in advanced care planning
An Evidence-Based Proposal Supporting Prostate Specific Antigen in Protective Service Occupations
Full text linkClinical Problem: Prostate cancer is the most common cancer among men in the United States and is the leading cause of death (CDC, 2021). Etiology of prostate cancer remains unclear but in recent research it has been shown that there is an association between occupation and prostate cancer risk (Sritharan, et al., 2019). Specifically protective service occupations including firefighters, policeman and detectives, guards, and watchmen (Sritharan et al., 2019).
Significance: With new evidence of risk factors, it is important that these individuals understand that they are at an increased risk of being diagnosed with prostate cancer. In 2018, New York State reported 15,714 cases of prostate cancer. With such a high incidence it is important that these individuals are participating in secondary prevention measures in the hopes that prostate cancer is caught early.
PICOT Question: This EBP proposal is framed around the following PICOT question: Among persons who are in protective service occupations, what is the impact of a Nurse Practitioner led shared decision coaching program that utilizes a decision aid on improved knowledge of prostate cancer, confidence in shared decision making for prostate cancer screening and patient satisfaction over 12 weeks?
Clinical Change: The change that will be implemented in this proposal is a nurse practitioner led shared decision coaching that will occur in a primary care setting with participants in protective service occupations. Education will be provided during the decision coaching and an opportunity to ask questions about prostate cancer and an individual’s specific risk factors will be allotted. Following the decision coaching the patient will be given the choice to have a PSA test ordered for them and if they decide to follow through with PSA testing, the nursing staff with take their blood draw then.
Desired Outcome: The desired outcome of this evidence-based proposal will include improved knowledge of prostate cancer specifically anatomy and function, risk factors, screening, and symptoms of prostate cancer. Other outcomes include increase in PSA testing with improved confidence in decision making regarding the testing and improved satisfaction with the interaction between the patient and nurse practitioner.
Summary: Through a review and synthesis of the literature, it was determined that the use of decision coaching and the use of decision aids are effective interventions for improving knowledge, satisfaction, and confidence
Tracing Debility and Webbing Resistance to State Violence through Crip Epistemologies
No full textUsing Puar’s line of analysis, we can trace how debilitating trauma can become a tool of the nation-state that creates racialized “mad people”: unruly, distressed, unbecoming, disposable in the eyes of the nation-state, yet necessary in their precarity and correct-ability
Conservative Management of a Foraminal Lumbar Disc Herniation
No full textA 39-year-old college professor presented to physical therapy via direct access, with a 2-month history of progressive lower back and right buttock pain. Following examination, the patient self-referred to a physiatrist, who ordered magnetic resonance imaging of the lumbar spine. Magnetic resonance imaging revealed a moderate, broad-based right foraminal disc herniation at L5-S1 encroaching on the right L5 nerve root exit
Fitness Watches and Nutrition Apps: Behavioral Benefits and Emerging Concerns
No full textApply It! By reading this article, the health and fitness professional will be able to understand how fitness watches and nutrition apps can influence self-monitoring and thereby, in turn, behavior change; and be able to recognize some of the emerging risks and associations between using fitness watches and nutrition apps and certain disordered behaviors
Examination of the Effects of Age, Sex, and Motor Ability Level on Balance Capabilities in Children with Cerebral Palsy GMFCS Levels I, II, III and Typical Development using the Pediatric Balance Scale
No full textPurpose: Explore effects of age, sex, and motor ability level on balance capabilities in preschoolers with and without Cerebral Palsy (CP).
Method: PBS was administered to 477 children 24 through 59 months: 258 with typical development (TD) and 219 with CP GMFCS levels I, II and III.
Results: 3-way ANOVA indicated PBS scores were significantly affected by age (F4,437=26.95, p
Conclusion: Children with TD outperformed children with CP GMFCS level I 36-59 months and children with CP GMFCS levels II and III 24-59 months. Expected performance values for children with TD and children with CP, ages 24-59 months, at GMFCS levels I, II and III are provided
Tamara Puffer, with Joyce Hollyday, Forgetting the Former Things: Brain Injury’s Invitation to Vulnerability and Faith (review)
No full textImplementation of a Nutrition and Lifestyle Modification Program for Patients with Obesity in the Primary Care Setting: An Evidenced-Based Proposal
No full textClinical Problem: Obesity is a multifaceted disease that affects the lives of millions of Americans each year. Obesity can lead to a plethora of other conditions, such as diabetes, heart disease, and certain types of cancer. Primary care practices can intercept patients suffering from obesity by identifying the problem and urging lifestyle changes; however, there is a lack of continuity of follow-up with regard to patients with obesity, which can lead to patients experiencing apathy, a lack of motivation, and a decrease in successful weight loss and lifestyle modifications.
Significance: The burden that obesity causes is vast, including the strain on the healthcare system as well as the sequelae of physical and emotional implications for patients and their families. According to the Center for Disease Control (CDC), the projected U.S. healthcare expenditure for obesity-related conditions is roughly $147 billion annually (2021). Furthermore, obesity increases the risks of developing a wide array of serious physical illnesses, such as hypertension, diabetes, ischemic heart disease, cerebrovascular accidents, and certain forms of cancer. Increased rates of depression are also associated with obesity (Gearon et al., 2020).
PICOT Question: This evidence-based proposal is intended to answer the question, “In patients with obesity, does a primary care nutrition and lifestyle management program help achieve weight loss and healthy lifestyle modifications?”
Clinical Change: Through a nurse practitioner-led nutrition and lifestyle change program, patients suffering from obesity could receive the support and guidance needed to be successful in losing weight and leading healthier lives. With this program, which will provide follow-up care and appointments, patients could be monitored periodically instead of relying on yearly physical assessments to address further concerns. Weight loss helps to mitigate the severity or risks of developing conditions such as heart disease and diabetes, which can lead to overall improvement of health, fewer complications, and fewer hospitalizations.
Desired Outcome: The desired outcome of the proposed clinical change is to achieve weight reduction of 5% of total body weight as well as an increase in physical activity and adoption of healthy lifestyle modifications in patients with obesity in the primary care setting.
Summary: Reviewing the literature and available evidence indicated that lifestyle management and nutrition programs for patients with obesity are underutilized in the primary care setting. This evidence-based proposal demonstrates a plan for implementation of a lifestyle-based, nurse practitioner-led program that focuses on nutrition and exercise counseling and periodic weigh-ins in order to reduce the impact of obesity on primary care patients
