LAIR: Lenoir-Rhyne Academic Institutional Repository
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Impact of Stress Management Training on Anxiety and Depression in Cardiopulmonary Rehabilitation Patients
Get PDFBackground: Patients with cardiac or pulmonary diagnoses are frequently referred to outpatient cardiopulmonary rehabilitation to improve clinical outcomes. With the American Heart Association elevating depression as a risk factor for cardiac disease along with anxiety and depression being common comorbidities for cardiac and pulmonary disease, cardiopulmonary rehabs have the distinctive opportunity to employ psychosocial interventions to improve mental health outcomes (Quindry et al., 2023). Purpose: This quality improvement project aimed to determine if participation in a stress management class improved PHQ-9 and GAD-7 scores in patients who attended phase II cardiopulmonary rehabilitation. Methods: Following screening for anxiety and depression, all patients participating in rehabilitation were encouraged to attend a stress management class offered six times over a three month-period. Data was collected and analyzed to evaluate pre- and post-PHQ-9 and GAD-7 survey results. A paired t-test was performed to determine if there was a statistically significant change in scores. Results: The primary diagnosis for most patients was related to cardiac disease (n = 35, 92.11%). Less than half of the patients 47.37% (n=18) attended one stress management class. 23.68% (n=9) had a history of depression, and 23.68% (n=9) had a history of anxiety, however, only 18.42% (n=7) of patients reported seeing a mental health provider. PHQ-9 scores decreased regardless of attendance, but those who attended had a larger decrease in average score from 7.67 (SD=6.23) to 3.94 (SD=4.36). GAD-7 scores decreased for those who attended a stress management class from 4.72 (SD=4.65) to 2.56 (SD=3.43), while those who did not attend saw an increase from 2.10 (SD=3.67) to 2.55 (SD=3.75). Recommendations and Conclusion: To align with AACVPR recommendations, cardiopulmonary rehabs should strive to improve psychosocial screening and education. Although stress management education did not appear to improve PHQ-9 and GAD-7 scores more than those who did not attend, those who attended stated that they didn’t realize the extent mental health impacted their physical health and many tried the techniques discussed including journaling and meditation. Moving forward, organizations should improve staffing and resources allocated to cardiopulmonary rehabs and investigate how to improve pulmonary patient recruitment to rehab and education
Newly Diagnosed Hospitalized CVA or TIA Patients with a History of Atrial Fibrillation either Known or Previously Diagnosed
No full textThe purpose of this study was to determine what percentage of a newly diagnosed cerebrovascular accident (CVA) or transient ischemic attack (TIA) patients within the hospital have a history of Atrial fibrillation, which is a common heart arrythmia. This topic is important due to its impact on treatment and preventative measures regarding a CVA or TIA. The treatment of atrial fibrillation can significantly impact the likelihood of experiencing a stroke and attribute to preventative measures. CVAs and TIAs can have a significant impact on a person’s health and overall well-being.
The current study found that 37 subjects (12.3%) of the newly diagnosed hospitalized CVA or TIA subjects had a history of Atrial Fibrillation. The average subject age was 71, there were multiple modes of 77 and 79 regarding subject age, these findings indicated a greater likelihood of vascular events at an increased age. Most subjects who had been newly admitted for a CVA or TIA were Caucasian at 87.3%. The sample was closely split with 53.7% of CVA or TIA subjects being female and 46.3% of subjects being male, indicating close prevalence for each gender, but greater for female subjects.
Researching the relationship between newly diagnosed CVA/TIA patients within the hospital and their history of atrial fibrillation will allow for increased knowledge regarding CVAs and TIAs. Cardiac monitoring and early detection of atrial fibrillation is a key component to preventing a CVA/TIA. Educating nurses, healthcare workers and patients regarding the relationship between Atrial fibrillation and CVA/TIA can improve patient outcomes
Physiological Profile of Competitive Collegiate Dancers
Get PDFCompetitive dance is a significant part of collegiate athletics. However, competitive dancers are not often recognized as athletes. Recognition of dancers’ sports status may provide them with access to better resources, such as strength and conditioning and athletic training care. This descriptive study of fitness characteristics in collegiate female dancers compares them to athletes from other female-dominant sports. Eight female collegiate dance team members (age: 19.5 ± 1.31 years, dance experience: 15.25 ± 4.66 years, height: 64.5 +/- 1.19, weight: 146 +/- 14.69) at an NCAA division II university completed multiple fitness tests, including body composition, muscular strength and power, aerobic fitness, and flexibility. The fitness test results are as follows: body fat percent = 32.44 +/- 13.31%, grip strength of dominant hand = 26.69 +/- 3.18kg, non-dominant hand = 24.75 +/- 4.77kg, vertical jump = 38.64 +/- 3.92cm, VO2 max = 41.34 +/- 8.09ml·kg-1·min-1, and sit-and-reach = 34.94 +/- 6.38cm. These data indicate that competitive dancers are comparable to other women collegiate athletes in multiple physical fitness parameters. Overall, there is a disparity in the popularity of dance and the esteem in which it is held. Dancers deserve to be treated like athletes because they work as hard as other athletes in their sport
Implementing the 5-2-1-0 Healthy Habits Toolkit for Enhanced Detection and Management of Childhood Obesity: A Quality Improvement Project in a Pediatric Clinic
Get PDFAbstract
Background: The prevalence of pediatric obesity continues to rise. This increases the risk of health complications. There is a lack of appropriate screening and multimodal interventions by health care providers to reduce the rates of pediatric obesity (Thomas et al., 2022).
Method: The 5-2-1-0 Algorithm for the Assessment and Management of Childhood Obesity for providers was implemented in a pediatric clinic. A random sample of 36 children, aged 5-12 years with weight percentiles >95%, completed the 5-2-1-0 Healthy Habits questionnaire, which was reviewed with their medical provider. A three-month pre-intervention retrospective chart review was conducted to assess baseline practices, followed by a three-month post-intervention review to compare changes in assessment and management of childhood obesity.
Results: Post-intervention analysis of 35 children revealed a significant increase in the documentation of obesity education, with 98.46% of participants having obesity education documented compared to 98.36% in the pre-intervention group (p = .028). However, while the use of the 5-2-1-0 algorithm resulted in a slight increase in obesity management orders (37.14% vs. 21.31%), these orders remained underutilized, with 62.86% of post-intervention participants not having orders placed, similar to pre-intervention trends.
Conclusion: The 5-2-1-0 Healthy Habits Toolkit effectively improved documentation of obesity education in pediatric primary care, but further efforts are needed to increase the use of obesity management orders. The toolkit's simplicity and efficiency make it a valuable tool for ensuring appropriate documentation and treatment plans for obese pediatric patients
The Effect of Positive and Negative Self-Talk Prompts on Free Throw Performance in Collegiate Basketball Players
Get PDFThis study examined the effect of positive and negative self-talk on free throw performance among collegiate basketball players. Self-talk refers to the internal dialogue athletes use to regulate focus, emotions, and behavior during performance. Prior research suggests that positive self-talk (e.g., “I can make this shot”) may enhance confidence and execution, while negative self-talk (e.g., “I suck at this”) can increase anxiety and disrupt performance (Galanis et al., 2022; Van Raalte et al., 1995; Van Raalte et al., 2015). Following IRB approval, eight participants were recruited from NCAA Division II men’s and women’s basketball teams. After completing baseline free throw attempts, participants performed two additional rounds using positive and negative self-talk prompts in a counterbalanced design. Chi-square analyses revealed no statistically significant differences in shooting performance across conditions. However, descriptive trends provided valuable insight. For example, the negative prompt “I will let my team down if I miss” resulted in the lowest shooting percentage (38%) among negative prompts, while “I am calm and focused” was the lowest among positive prompts (63%). Conversely, some negative prompts—such as “I suck at free throws”—yielded unexpectedly high success rates (100%), potentially due to athletes’ humorous or dismissive interpretation of the statements. These findings suggest that the content, tone, and delivery of self-talk may influence its effectiveness. While statistical significance was not achieved, the study highlights the nuanced ways athletes respond to cognitive prompts and offers direction for future research and applied sport psychology practice
Implementation of Low Barrier Wound Care Protocols in Community Based Settings
No full textThe primary objective of this quality improvement (QI) project was to implement low-barrier wound care protocols in two community-based settings to increase wound healing, reduce wound-related complications, and decrease patient reliance on EMS and EDs
Measuring the Benefits and Impacts of the North Carolina Local Health Department Accreditation (NCLHDA) Program: A Qualitative Analysis
Get PDFBackground: Local health departments (LHDs) are at the core of the public health system. With the first LHD in NC being established in 1912, the state now boasts 86 (with some operating as district/multi-county) departments that cover all 100 counties. To ensure that LHDs in the state are extending their services to all communities in a proper manner, and to hold them accountable, LHD health directors, combined with the state legislature, developed and passed an official accreditation process; Senate Bill 804. As a result, the process of LHD accreditation in NC became law in 2006, making NC the first state to require such. This legislation led to the creation of the North Carolina Local Health Department Accreditation board and program. The NCLHDA program has established 5 standards, 41 benchmarks, and 147 activities that LHDs are expected to meet. According to Subchapter 48A, “Local Public Health Department Accreditation” of Title 10A, “Health and Human Services”, of the North Carolina Administrative Code, to achieve the status of accredited, an LHD must satisfy all 5 of the standards and 41 benchmarks, as well as numerous activities within each standard. The purpose of this research was to measure the benefits and impacts of the NCLHDA program.
Methods: Participants: The participants in this study included the 106 Local Health Department Health Directors in North Carolina, as well as the 86 NC LHD Agency Accreditation Coordinators (AACs). Procedures: This research used a cross-sectional design with a 7-question survey as the instrument of measure. The survey was sent 4 times over a span of 7 weeks to all NC LHD Health Directors and Agency Accreditation Coordinators. Analysis: A complete thematic analysis of survey responses was conducted. Keywords and phrases were extracted from survey responses and placed into a Microsoft Excel sheet. These keywords and phrases were assigned to codes and were then read and re-read in order to allow for themes to inductively emerge from the data.
Results: At the end of the data collection period, 67 survey responses were recorded in total. Of the 67 responses, there were 3 LHDs who submitted two responses and one LHD who submitted a blank response for each question. Taking these responses into account, there were 63 unique LHD responses, which represents 73% of all LHDs in NC. The thematic analysis resulted in over 300 codes assigned to responses, with 8 total themes and several counterthemes emerging from the data which highlighted the various benefits and impacts of the NCLHDA program. The most potent of these benefits being an increased ability to recognize internal weaknesses, and an increased accountability to adhere to the 10 EPHS. Analysis of the data also reveals that the accreditation process can be used as a tool to foster better engagement with LHD governing bodies, as well as a tool for the development of essential policies.
Conclusion: The themes that emerged from the survey responses collected clearly identified that there are various benefits of the NCLHDA program, and the process involved with accreditation, as well as potential drawbacks and negative impacts
Implementation of the RASS-Pal Tool to Improve Sedation Practices for End-of-Life Care
Get PDFBackground: Symptom management for patients at the end-of-life has been identified as an important part of care for patients and their families. Sedative medication should be proportionate to the patient’s suffering and the level of sedation should be monitored to ensure patient comfort (Vivat et al., 2019). A hospital based acute palliative care unit providing end-of-life care was found to lack an assessment tool for sedation and agitation approved for utilization for patients receiving end-of-life care.
Purpose: This quality improvement project implemented the RASS-Pal assessment tool to determine its impact on end-of-life nursing care provided and nurse confidence in the ability to assess, treat, and report patient sedation levels.
Methods: Prior to education on the RASS-Pal tool, nurses completed an anonymous survey to measure knowledge and confidence related to end-of-life sedation practices. Education on the tool was provided, and the tool was implemented for patients meeting inclusion criteria. Nurse confidence was assessed following implementation utilizing self-reported anonymous surveys. Medication administration trends were assessed during implementation via chart review.
Results: There was no statistically significant change in nursing confidence in reporting sedation or in medication selection but there was a strong correlation between the ease of use of the tool and its helpfulness monitoring patient sedation at end-of-life. Following implementation of the RASS-Pal tool, an average of more than 10 sedation assessments were documented for each patient compared to no sedation assessments documented before the tool was implemented.
Conclusion: Implementation of the RASS-Pal tool may be beneficial for use in patients receiving end-of-life care to facilitate standardized assessment of patient sedation. Further studies would be helpful to better understand the impact of the RASS-Pal tool on patient comfort and medication administration practices
Increasing HPV Vaccination Rates in a Pediatric Based Clinic
Get PDFHuman Papillomavirus (HPV) is the most common sexually transmitted infection in the United States. This pre- and post-intervention quality improvement project aimed to evaluate the effect of bilingual educational videos, accessed via QR codes, on HPV vaccination rates in pediatric population ages 9-17
The Nursing Impact: Analyzing the Effects of Nursing Education on the Quantification of Blood Loss and Postpartum Hemorrhage
Get PDFBackground: Postpartum hemorrhage (PPH) is an obstetric medical emergency, which is effectively managed when blood loss is accurately measured for total volume. Quantitative blood loss (QBL) is the most accurate measurement tool used to quantify the amount of blood lost during and following cesarean section delivery. Methods of QBL measurement should be standardized for all patients and should be easily translatable to ensure accuracy and timely PPH intervention methods. Ensuring that nurses are educated on QBL measurement practices is paramount to ensuring accuracy in recording blood loss and implementing timely interventions.
Purpose: This quality improvement (QI) project aimed to impact patient outcomes by improving upon the current quantification methods of blood loss to promote greater accuracy and increased recording of QBL, as well as improved management of obstetrical hemorrhage in the Post Anesthesia Care Unit (PACU). It further aimed to assess and improve the education level of nurses who are responsible for quantifying and reporting blood loss, allowing for improvements in QBL recording and interventions (when medically necessary).
Methods: This QI project used randomized chart auditing methods to assess blood loss measurement and interventions prior to, and subsequently following a nurse educational intervention session focused on accuracy of QBL measurement in the PACU. The education provided nurses with understanding and a demonstration of standardized QBL measurement methods and appropriate intervention practices based on the amount of blood loss. Following a three-month implementation period, a comparative analysis was performed to assess for improvements in QBL measurement and interventions in the PACU.
Intervention: Education was provided to staff nurses to evaluate the effects of an evidence-based in-person educational session on improvement in the practice of utilizing and reporting quantitative blood loss and interventions in the Post Anesthesia Care Unit following cesarean section deliveries.
Results: There was an increase in the number of instances in which PACU QBL was measured and recorded from 20% (pre-intervention) to 33% (post-intervention). However, this improvement did not reflect a significant improvement (x2 = 1.14; p = 0.285).
Conclusion: The educational intervention provided to PACU nurses increased nurse awareness and knowledge of QBL measurement, but did not greatly improve the consistency of nurse likelihood to consistently perform these measures during the PACU recovery period