1697 research outputs found
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Reducing 30-day Post-Stroke Readmissions with a Discharge Checklist Tool
Full text linkProblem: The practice site, a nationally certified stroke care hospital, faced challenges with 30-day post-stroke readmission rates of 8.7%, below the national average of 12.44%. This quality improvement initiative aimed to reduce avoidable readmissions to below 4.7% by implementing a structured education process using a post-stroke checklist for all stroke admissions.
Aim of the Project: The primary goal was to ensure that all stroke patients received consistent discharge education. This was achieved by introducing the American Heart/Stroke Association Post-Stroke Discharge Checklist, aligning with best practices to standardize patient education.
Review of Evidence: Evidence shows inconsistencies in the discharge process, particularly with novice staff, often lead to inadequate patient education on stroke risks, prevention, and follow-up care. Poor discharge planning contributes to unplanned readmissions, functional decline, and financial strain on both healthcare systems and patients.
Project Design: This quality improvement project, conducted on the Integrated Stroke Unit, involved providing a post-stroke discharge checklist to all stroke patients. Patients and caregivers were encouraged to ask questions, take notes, and complete the checklist before discharge with staff assistance. The OhioHealth Change Management Model guided systematic improvements in stroke education, with two PDSA cycles testing changes during the project.
Intervention: Upon admission, patients and caregivers received the post-stroke discharge checklist and an explanation of its purpose. Staff provided education throughout the patient\u27s stay, ensuring understanding and documentation of checklist completion at discharge. Weekly audits were conducted and reported during staff huddles.
Significant Findings/Outcomes: The project successfully reduced 30-day post-stroke readmission rates from 8.7% to 3.9%, surpassing the target of 4.7%. This underscores the importance of patient/caregiver collaboration in improving education and reducing avoidable readmissions.
Implications for Nursing: Improved patient education enhances nursing practice by reducing unplanned readmissions, which place financial and operational burdens on patients and healthcare staff. This aligns with the IOM’s six domains of healthcare quality: providing safe, effective, patient-centered, equitable, efficient, and timely care. In eight weeks, the unit successfully reduced post-stroke readmissions through adequate education
Exploring the Security Landscape of Underwater Positioning and Navigation Systems: An Attack Surface Analysis
No full textUnderwater positioning and navigation systems are vital for maritime operations but face significant security threats like spoofing, jamming, interception, sensor manipulation, and algorithm exploitation. This paper categorizes underwater navigation techniques (acoustic, GPS buoys, multi-sensor fusion, vision-based, hybrid) and analyzes their potential attack surfaces. To mitigate these threats, a multi-layered defense strategy is proposed, encompassing cryptographic authentication, secure communications, physical security, sensor redundancy, data validation, image authentication, and algorithm robustness. Specific countermeasures against jamming, spoofing, interception, sensor attacks, and algorithm attacks are discussed. A holistic approach integrating secure software practices, anomaly detection, and fusion technique diversity is emphasized to fortify system resilience against advanced persistent threats, ensuring maritime safety and security. This research contributes to understanding security vulnerabilities and providing a comprehensive mitigation framework for enhancing the resilience of underwater navigation systems
Silenced and Marginalized: A Qualitative Study of Gendered Racial Microaggressions Among Black Female Graduate Students
No full textBlack women face unique challenges based on the intersection of multiple marginalized identities often referred to as the simultaneity of oppression or gendered racism. The purpose of this qualitative study is to expand gendered racial microaggression research by examining the experiences of Black female graduate students at colleges and universities not classified as historically Black. This study utilized a Critical Race Feminism framework that centered the voices and perspectives of the participants and sought to answer the following research questions: RQ 1: How do Black female graduate students experience gendered racial microaggressions at colleges and universities not classified as Historically Black Colleges and Universities (non-HBCUs)? RQ 2 : How do Black female graduate students cope with their experiences of gendered racial microaggressions at non-HBCUs? Individual semi-structured interviews were conducted with 15 Black female participants who have attended non-HBCUs during their entire collegiate journey. A thematic analysis approach was utilized to analyze the data and identify patterns and themes. Three core themes with two subthemes emerged in relation to research question one: Isolated and Silenced (Only Black Person, Lack of Support), Common Stereotypes (Angry Black Woman, Jezebel), Permanence of Racism (A History of Racism, The Decline of Diversity, Equity, and Inclusion). Two core themes with two subthemes were identified in relation to research question two: Identity Shifting (Fear of Consequences, Fear of Perpetuating Stereotypes), Community Building (Faculty, Administrators, and Advisors, Student-peers and Co-workers). A robust discussion of these findings is presented along with practical and theoretical implications of the study and recommendations for future gendered racial microaggression research
Which Chemotherapy Treatment Setting Best Predicts the 5-year Survival Rates in Women Diagnosed with Triple Negative Breast Cancer?
No full textFemale breast cancer contributes to over two million cancer cases each year worldwide and remains a top contributor to mortality. Expedient treatment may mean the difference between positive and negative survivor outcomes but when facing an aggressive subtype with no targeted treatment, how do oncologists get quick and correct care to their patients? Triple negative breast cancer accounts for approximately 15% of all breast cancer diagnoses each year. These patients are faced with a highly aggressive cancer that lacks positivity for all three molecular markers that can guide treatment. These patients are often younger, have multiple comorbidities, and have socioeconomic disparities that may affect their access to care. Understanding that triple negative breast cancer is chemosensitive, polychemotherapy remains the backbone of TNBC treatment. This research will delve into predictors that can affect time to treatment and survivor outcomes based on chemotherapy setting administration (adjuvant or neoadjuvant). This quantitative study utilizes the National Cancer Database – Public Use Files to identify triple negative breast cancer patients residing within the mid-Atlantic (New York, New Jersey, Pennsylvania) between 2004 and 2014 who had both chemotherapy and surgery as their treatment protocol (n = 4,528). Using generalized linear models and Cox Proportional Hazard Regressions, the data found that women treated in a comprehensive community cancer program had an average time to treatment of 3.7 days from date of diagnosis. Patients who were privately insured encountered a margin decrease in treatment time, waiting 3.5 days. Additionally, the analysis indicated that there is no significant difference in survivor outcomes at 60 months between adjuvant or neo-adjuvant chemotherapy administration. Hospital administration and healthcare leaders must be capable of providing insight and support to clinicians and encourage multidisciplinary collaboration. This collaboration can lead to organizational change by developing solutions that benefit patient outcomes, maintain financial stewardship, and improve quality and regulatory compliance
Achieving Tribal Gaming Regulatory Excellence: A Narrative Analysis Using Indigenous Persons Methodology
No full textThe Indian Gaming Regulatory Act (IGRA) of 1988 enabled Native American Tribes to operate high-stakes gambling casinos, leading to 244 Tribes participating in casino gaming by 2022 and generating $40.9 billion in gross gaming revenue. Tribal gaming regulators face the task of examining a range of complex factors to ensure effective regulation, which, while not aimed at profit generation, can have an indirect effect on casino profitability. This relationship underscores the shared practices between Tribal regulatory agencies and casino enterprises. Despite the critical role of these agencies, there is a noticeable gap in academic research on the regulatory practices and performance of Tribal Gaming Regulatory Agencies (TGRAs). This qualitative study investigates the factors influencing TGRA actions and practices, with the goal of supporting high-performance and quality regulatory outcomes. Adopting a qualitative approach, the study uses Two-Eyed seeing, which combines Indigenous and Western perspectives through interviews with fourteen active Tribal Gaming Regulators (TGRs) across eight U.S. regional districts under the National Indian Gaming Commission\u27s authority. The integration of Western academic research with Tribal regulators\u27 insights aims to offer useful recommendations for TGRs working toward regulatory effectiveness. Keywords: Indigenous, Indian Gaming Regulatory Act, regulatory excellence, Tribal Gaming Regulator (TGR), Tribal Gaming Regulatory Agency (TGRA), Two-Eyed seeing (TES
Evidence-based Strategies for Fall Prevention
Full text linkPatient falls represent the largest category of preventable adverse events in hospitals, with 700,000 to 1,000,000 falls occurring annually in U.S. hospitals and 30-35% resulting in injuries. The cost of fall-related injuries exceeds 14,056 per fall.
The aim of this project was to introduce a standardized fall prevention approach to improve performance and reduce falls in the medical-surgical department.
A comprehensive literature review indicates multifactorial bundled approaches, clinical pathways, purposeful rounding, and patient and family engagement as effective fall prevention strategies.
This quality improvement (QI) project design was based on the Plan, Do, Study, Act (PDSA) Model for Improvement principles. The OhioHealth Change Management Model tools were instrumental in guiding the change by facilitating both the design and implementation of the project.
The project utilized a multifactorial approach with bundled interventions, including timely fall risk assessments, a structured, purposeful rounding method, gait belt availability, and patient-centered care plans and education, to enhance the existing fall prevention program.
The fall rate decreased by 35% from the baseline, and the fall-with-injury rate reduced by 63% within the two months. Compliance with fall risk assessments and purposeful rounding improved significantly, while care plan and education documentation showed moderate increases.
Bundling evidence-based fall prevention interventions demonstrated a reduction in falls and improved patient safety. Establishing a standardized fall prevention program with patient-centric interventions may enhance safety outcomes