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A Quality Improvement Project to Reduce Facility-Acquired Pressure Injuries
Get PDFProblem: Facility-acquired pressure injuries (FAPIs) pose significant risks to patient outcomes and healthcare costs (70,000 per PI) in subacute rehabilitation (SAR) facilities. An assessment in a SAR identified a concerning pressure injury (PI) rate of 15.3%, exceeding the national benchmark of 10% for such facilities. This prompted an evidence-based quality improvement (QI) initiative.
Aim of the Project: This project aimed to reduce FAPI rates by 30% or greater among patients 65 and older using a PI prevention bundle called SSKINS (Skin, Surface, Keep moving, Incontinence/moisture, Nutrition/hydration, Self-management).
Review of the Evidence: A comprehensive literature review indicated that PIs result from prolonged pressure on bony prominences, shear forces, and moisture. Evidence supports that protocol-driven bundles, such as SSKINs, reduce PI incidence in various healthcare environments and across patient populations.
Project Design: This QI project design was based on Deming\u27s Model for Improvement framework focusing on enhancing patient care by standardizing processes. The project team used iterative plan-do-study-act (PDSA) cycles to implement, evaluate, and refine the intervention. OhioHealth Change Management Model tools were used to facilitate stakeholder engagement and develop an effective communication strategy for the project.
Intervention: The SSKINS bundle was implemented through comprehensive staff education. Key components included repositioning every two hours, thorough skin assessments each shift, mobility promotion through rehabilitation medicine, incontinence management with prompt cleaning and barrier cream application, nutritional support with dietary consultations, and patient/family education on self-management techniques.
Significant Findings/Outcomes: The project yielded substantial results, in line with existing literature. In 12 weeks, FAPI incidence rates dropped by 100%, from a baseline rate of (19%) 19 FAPIs per 100 patient admissions to zero. The bundle compliance scores increased significantly, from a baseline rate of 50% to 95%.
Implications for Nursing: The outcomes of using the SSKINS bundle demonstrate the effectiveness of evidence-based practices in PI prevention. This success highlights the critical role of nurses in executing prevention strategies. However, this achievement is not the end. It is crucial to recognize that sustaining these improvements in PI prevention and overall high-quality, patient-centered care requires nurse empowerment through education with skills and resources, engagement, and compliance
The Influence of Palliative Care on Savings for Hospitals: A Qualitative Descriptive Study
No full textThis qualitative descriptive study explored how healthcare administrators (Pulmonary, Cardiology, or both) describe the influence of Palliative Care on savings for hospitals in the United States. Palliative Care is a supportive service that collaborates with specialists, Primary Care, patients, and families to provide quality care for those with chronic and serious illnesses. Palliative Care is a holistic service that meets physical, social, psychological, and spiritual needs. Patients with congestive heart failure and chronic obstructive lung disease tend to overutilize healthcare services such as the emergency room, admissions, readmissions, and intensive care unit stays. Palliative Care savings are not easily demonstrated on a revenue report but spread across the healthcare system. Hospital leadership may not provide resources for services with a perceived decrease in return on investment. Systems Theory is the central concept used for this study. Systems Theory is how the sum of individual teams or people work together to benefit the patient and, therefore, savings to the hospital. The study\u27s question inquired about the healthcare administrator\u27s experience with Palliative Care and associated hospital savings. The study collected 17 anonymous online surveys utilizing Microsoft Forms from healthcare administrators in the United States. The term healthcare administrators included healthcare administrators, directors, medical directors and managers working in Pulmonology, Cardiology, or both. This researcher invited participants through a recruitment flyer on the investigator’s personal Facebook and LinkedIn pages, Facebook and LinkedIn group pages, and Reddit. An invitation was also sent to LinkedIn Connections and Facebook Friends by direct message for those who may be eligible for the study. Participants participated anonymously, and the researcher asked them to refrain from responding over direct messages. The researcher analyzed data using ATLAS.ti. Four themes emerged utilizing Braun and Clarke’s (2013) Thematic Analysis: Palliative Care Assists with Decision-Making, Palliative Care is Comprehensive Care, Palliative Care Leads the Way with Education and Quality, and Palliative Care Decreases Utilization and Increases Cost Savings
Challenges and Accessibility of Physician Health Programs for Physicians with Substance Use Disorders
No full textPhysician wellness is an issue of concern especially when it comes to potentially impairing conditions like Substance Use Disorder (SUD). Physician Health Programs (PHPs) exist to help physicians when they are struggling with SUD, but there is reluctance to utilize them because of stigma. Through an action-based qualitative process, this study surveyed PHP director level leaders to gain their perspective on how to overcome stigma and reluctance to ask for help. The feedback from the study’s participants developed a proposed training program to enhance PHPs messaging through education and outreach. PHP director level leaders where emailed and opened-ended survey that asked questions around challenges, improvements, and processes in relation to monitoring physicians for SUD. The responses were then analyzed to develop a proposed training program for PHPs. The study concluded that PHPs and physician stakeholders contribute to the stigma physicians feel around SUD and that education to stakeholders and physicians was critical in overcoming the stigma. The education provided by PHPs required to focus on PHP needs from stakeholders, and PHP purpose with physicians
Application of a Mepilex Border Dressing to Prevent Heel Pressure Injury
Get PDFProblem:
Heel pressure injuries (HPIs) are preventable, yet they can easily occur when policies specifically targeting heel protection are lacking. A quality improvement methodology was implemented on two intensive care units (ICUs) within an organization which involved revising existing policies to standardize practices and mitigate occurrences.
Aim of the Project:
To evaluate the effectiveness of an evidence-based protocol that utilizes Mepilex border dressings to prevent hospital-acquired HPIs in ICUs. Review of the Evidence:
Across various studies, common themes emerged, notably the utilization of prophylactic Mepilex foam dressings as effective interventions specifically targeted in the ICU. Project Design:
A protocol was established to prevent hospital-acquired HPIs on two ICUs. Baseline and final surveys were distributed to assess change readiness and progress. Four key process measures were analyzed from nursing documentation over eight weeks. The project utilized the Plan-Do-Study-Act (PDSA) cycle to enhance sustainable improvements. Outcomes were collected pre- and post-implementation, and Ohio Health Resources offered guidance on sustainability at the project\u27s conclusion. Intervention
Implementation of an evidenced-based protocol using the application of Mepilex border dressings to prevent HPIs. Significant Findings/Outcomes
Key process measures:
Comprehensive skin assessments: Met 80% goal, both units
Use of Braden scale: Met 80% goal, both units
Application of the Mepilex border dressing: Unit A had a 12.14% and Unit B had a 26.14% compliance rate, although improvements in nursing documentation and practice occurred in some weeks.
Dressing Changes within 72 hours of Application: 0% compliance, both units.
Outcome measure:
ICU A, there was no change in the rate of hospital-HPIs, 0.3% incidence rate pre and post project implementation.
ICU B, showed a slight increase of 0.3%
Implications for Nursing
Nurses play a critical role in identifying at-risk patients and implementing strategies to prevent HPIs. To support this, healthcare organizations should establish standardized, evidence-based policies for prevention. Despite outcomes in the two ICUs, there is a clear need for broader adoption of the Mepilex Border dressing across all healthcare settings
Charting New Waters with CRAMMTS: A Survey-driven Cybersecurity Risk Analysis Method for Maritime Stakeholders
No full textThis article presents a novel survey-based cybersecurity risk assessment model, CRAMMTS (Cyber Risk Analysis Method for Maritime Transportation Systems), specifically designed for the maritime sector, addressing a critical gap in the literature. Our study contributes significantly in three ways: firstly, through a comprehensive critical literature review of 31 maritime guidelines and 95 scholarly articles, identifying the need for a new cybersecurity risk assessment method; secondly, by developing CRAMMTS, an adaptation of the ISRAM risk analysis method, incorporating the International Maritime Organization\u27s criteria and enabling participation from maritime professionals, especially policymakers and leaders. The third contribution is a case study, the practical application of CRAMMTS in surveying 80 maritime professionals, assessing their perception of cybersecurity risks, and identifying varying risk levels, with the highest associated with cyber threat actors. This approach proved effective in assessing risks at both tactical and strategic levels and providing a clear, quantitative risk metric for decision-making. Our research underscores the maritime sector\u27s need for a holistic, easily implementable cybersecurity risk analysis method that engages leaders and adapts to various Maritime Transportation System scopes, thereby enhancing cybersecurity risk assessment in this crucial domain.
This article presents a novel survey-based cybersecurity risk assessment model, CRAMMTS (Cyber Risk Analysis Method for Maritime Transportation Systems), specifically designed for the maritime sector, addressing a critical gap in the literature. Our study contributes significantly in three ways: firstly, through a comprehensive critical literature review of 31 maritime guidelines and 95 scholarly articles, identifying the need for a new cybersecurity risk assessment method; secondly, by developing CRAMMTS, an adaptation of the ISRAM risk analysis method, incorporating the International Maritime Organization\u27s criteria and enabling participation from maritime professionals, especially policymakers and leaders. The third contribution is a case study, the practical application of CRAMMTS in surveying 80 maritime professionals, assessing their perception of cybersecurity risks, and identifying varying risk levels, with the highest associated with cyber threat actors. This approach proved effective in assessing risks at both tactical and strategic levels and providing a clear, quantitative risk metric for decision-making. Our research underscores the maritime sector\u27s need for a holistic, easily implementable cybersecurity risk analysis method that engages leaders and adapts to various Maritime Transportation System scopes, thereby enhancing cybersecurity risk assessment in this crucial domain
Analyzing the Janus Decision’s Impact on Public Sector Unions and Labor Relations
No full textThis qualitative study provides a comprehensive exploration of the far-reaching implications of the Supreme Court\u27s Janus v. AFSCME decision on both unionized public sector employees in leadership positions and labor relations managers. The Janus decision, which prohibited public sector unions from collecting mandatory fees from non-consenting employees, has altered the landscape of labor relations. The research investigates the experiences of unionized public sector employees in leadership roles and labor relations managers before and after the Janus decision. Moyang (2023) authored that Self Determination Theory (SDT) has three psychological needs. They are autonomy, competence, and relatedness. The study\u27s incorporation of SDT adds a psychological element to the understanding of union involvement. Additionally, the study explores organizational relationships and the influence of interactions and networks on collaboration and support. Miller (2023) authored that qualitative research is utilized to identify patterns or themes within datasets utilizing thematic analysis. Thematic analysis was employed to identify key themes and patterns within the collected data, ensuring a nuanced understanding of the diverse viewpoints of union employees in leadership positions and labor relations managers. By incorporating the perspectives of both these groups, the research contributes valuable insights to the existing literature on the consequences of the Janus decision. This analysis provides an academic viewpoint on the connection between work relations and unions. By clearly defining the paths of labor relations managers and union leaders, the research establishes theoretical frameworks for navigating today\u27s labor relations
Mixed Method Study to Examine Leadership Characteristics that Result in Collaboration and Distributive Ministry with Team Engagement: Evidence-Based Solutions for Pastoral Leaders to Navigate the Responsibilities of 21st-Century Congregational Ministry to Lessen Burnout
No full textThis research sought to define pastoral leaders\u27 leadership characteristics in congregational settings that create collaborative and distributive ministry leadership through team engagement. The purpose of this research was to examine leadership characteristics resulting in collaboration and distributive ministry leadership with team engagement. The research aimed to help pastoral leaders with the responsibilities of 21st-century congregational ministry and lessen the experiences of burnout. Study participants were pastoral leaders and at least two council members from congregations affiliated with the Evangelical Lutheran Church in America (ELCA) in the Southern Ohio Synod (SOS). The mixed methods concurrent QUAN-qual study utilized the Leadership Practices Inventory and the Shared Professional Leadership Inventory to measure various leadership characteristics and team engagement in the quantitative strand. The qualitative strand used three open-ended questions to assess further the presence of team engagement and pastoral leaders’ leadership characteristics. The research question encompassed several components, including the leadership characteristics of pastoral leaders and the relationship between specific leadership characteristics of Transformational, Servant, and Shared leadership models and team engagement. The study findings found relationships between several leadership behaviors and team engagement in congregations. The research into leadership characteristics and team engagement assisted in the development of a best practices profile and training outline for congregational pastoral leaders to share and distribute ministry responsibilities with members to reduce feelings of burnout
Qualitative Study: Positive and Negative Mentoring Practices in the Corporate Workplace and the Impact the Practices have on the Black Male
No full textThis research explored Black male mentees’ experiences related to workplace advancement. Of all fortune 500 company CEOs only eight are Black. The research showed that workplace advancement does not keep pace with the Black male population numbers. Related to White males, there is a disparity in officer-level attainment of the Black male in the corporate workplace. There is a gap in the research on Black male mentees and their workplace advancement. This research explores mentoring and Black male advancement opportunities in the corporate workplace. The goal of the research is to develop more practical mentoring experiences for Black males in the workplace. Using critical race theory and appreciative inquiry to frame the research was critical. Being aware of the probable systemic racial impact and incorporating the positive development approaches of appreciative inquiry benefited the study. This qualitative research is exploratory. Exploring the impact of mentoring on the journey of 15 Black males and how they conceptualized the impact of mentoring on their climb of the corporate ladder. Information from the interviews was analyzed and coded by themes multiple times to present a non-biased review of the participants’ perspectives. Two of the interviewees, now retired, made it to the top of their industry. Results indicate a lack of success in Black males moving from the mentee role to the officer level in the corporate workplace. Implications for the practice include developing positive cultural awareness and unbiased mentoring programs in the workplace