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Integrating Medical Assistant Education on Depression Screening for Adults in Primary Care
No full textAbstract
Depression is a leading cause of disability worldwide and significantly impacts years of productive life. Despite the availability of evidence-based treatments, a substantial proportion of individuals with depression do not receive adequate screening assessments. Primary care providers (PCP) play a critical role in identifying and managing depression, often being the first point of contact for individuals for all medical needs but face barriers to conduct screenings regularly. Educating medical assistants (MAs) on the impact that depression has in primary care as well as providing the skills to administer established depression screenings can improve early detection and treatment in the primary care settings. This integrative review aims to evaluate the effectiveness of training MAs in using validated screening tools to improve detection of depression and care coordination among adult and older adults (65 years and over).
The literature suggests that the inclusion of well-educated and trained MAs on the health care team specific to depression and mental health disorders in the primary care setting can improve screening rates and patient outcomes. This collaborative approach enhances both the patient experience and the overall efficiency of care delivery to accommodate with the expanding number of patient populations.
Keywords: depression, adults, screening, primary care provider, education, training, medical assistan
Click to Book: Improving Senior Health Management Through Technology Workshops
No full textThis Quality Improvement (QI) Project aims to improve older adult residents’ confidence in using technology to access their medical information and enhance their health literacy through targeted technology workshops. The QI Project was conducted at Facility A, a senior living community, with approximately 160 residents. The primary aim was to increase participants’ confidence in using technology from 0% to 75% by March 31, 2025. Over six weeks, residents were invited to attend individualized technology workshops focused on accessing patient portals, managing online health records, and using mobile devices for health-related tasks. Outreach strategies included distributing fliers to each resident’s door and placing additional notices in common areas, with support from facility staff in recruitment. Participant progress was evaluated using pre- and post-intervention self-assessments and satisfaction surveys. Only 10% of residents participated in the workshops, with limited engagement during the initial weeks. However, interest increased toward the end of the program. Among those who participated, confidence was significantly improved using technology to manage their healthcare, and feedback indicated that the sessions were beneficial. Language barriers were identified as a key limitation, affecting some residents\u27 ability to fully participate. Despite low participation rates, the project demonstrated that personalized technology workshops can meaningfully increase confidence and promote digital health engagement among older adults. Increased interest toward the end of the project suggests potential for future scalability. Addressing barriers such as language differences may enhance participation and outcomes in subsequent initiatives
Enhancing Palliative Care Knowledge and Empathetic Communication in Assisted Living: An Educational Quality Improvement Initiative
No full textObjective: Palliative care education in assisted living facilities remains underdeveloped despite its essential role in promoting patient-centered, compassionate end-of-life care. This project sought to address gaps in knowledge and confidence surrounding palliative care among staff and residents (Sisters) by building on existing evidence that early education and communication improve end-of-life outcomes. Aim: This quality improvement initiative aimed to enhance understanding of palliative care principles and increase comfort discussing end-of-life needs among residents and staff at a faith-based assisted-living community. Methods: Education was delivered through tailored powerpoint video presentations, in-person sessions, and printed handouts, followed by pre- and post-intervention surveys measuring changes in knowledge and self-reported confidence. Results: Post-intervention findings demonstrated a 28.6% increase in understanding of palliative care concepts and 16.5% improved comfort discussing end-of-life needs amongst residents, with staff results inconclusive. Conclusions: These results underscore the value of incorporating palliative care education into long-term care settings, where improving communication, symptom awareness, and end-of-life preparedness can foster more empathetic, patient-centered care while promoting dignity and comfort for residents nearing the end of life
Charting the Course: Improving Psychotropic Medication Documentation Through Staff Education to Promote Patient Safety and CMS Compliance
No full textThe University of San Francisco master’s level nursing program culminates with a clinical nurse leader (CNL) quality improvement project. The objective of this project is to reinforce the program’s didactic CNL classes by allowing students the opportunity to design, implement, and analyze a quality improvement project in a microsystem. SETTING: Skilled nursing facilities often prescribe psychotropic medications to help manage residents’ behavioral and psychological symptoms. Due to the possibility of side effects and increased sedation, there are concerns for patient safety and quality of life. Inadequate management of these patients and symptoms compromises patient safety and breaches state and federal regulations. OBJECTIVE: The site for the QI project had 0% documentation compliance and
data collected revealed low levels of nurse understanding and knowledge regarding
documentation requirements and regulatory compliance. AIM: To evaluate the effectiveness of a teaching intervention to enhance nurse knowledge and confidence to meet regulatory and quality compliance. METHODS: Nursing staff received education and resources to increase their knowledge, comfort, and adherence to documentation standards. In addition, emphasis was put on the importance of documentation and observation for patient safety. Pre- and post-intervention survey data measured nurses’ understanding and comfort with documentation requirements. RESULTS: Average nurse confidence with psychotropic medication documentation increased from 44.4% to 60.7% post intervention. Knowledge of documentation processes improved from 80% to 85.7%. However, staff knowledge of CMS criteria for unnecessary use of psychotropic medication decreased from 77.8% to 42.8%. CONCLUSION: This project highlighted the effectiveness of educational interventions to increase nursing understanding and comfort with documentation standards. Although there were improvements in nurses’ self-reported knowledge, continued education on staff knowledge of CMS requirements is needed. In addition, follow up is required to understand the long term effects of this increased comfort and understanding on actual documentation practices. The team suggests ongoing staff education and follow up analysis of documentation complianc
Signs of Feasibility: Implementing a Bedside Visual Cuing System to Potentially Reduce Hospital-Acquired Pressure Injuries in Acute Care Units
No full textObjective: Hospital-acquired pressure injuries remain a patient safety concern despite standard practice of nurses’ prevention protocols (National Pressure Injury Advisory Panel, 2022). Barriers include: inconsistent two-hour repositioning, documentation burden, inadequate staffing, lack of visual cues of patient risk level and inconsistent compliance with the overall comprehensive prevention bundle (Agency for Healthcare Research and Quality, 2023). Aim: HAPIs occur within two adult medical-surgical and telemetry units at a tertiary hospital. In response, staff were surveyed on potential interventions, resulting in the production of a visual cueing system. Methods: Pre- and post-surveys were conducted on the two medical-surgical units to assess staff knowledge of HAPI prevention methods. Specific unit’s needs were assessed to identify feasible interventions. Results were compared to determine the effectiveness of quality improvement measures. Intervention: A two-week intervention distributed modified visual fliers featuring Braden Score protocol during huddles on both units. The fliers outlined moderate- and high-risk criteria and reinforced two-hour repositioning. Floor-wide audits during the intervention assessed the fliers’ viability, compliance, and use. Results: About 67% of staff nurses reported adopting the HAPI Prevention Tool flyer into their daily practice for its potential effectiveness in decreasing HAPIs and improving patient care. Conclusion: Staff strongly supported the cueing tool. However, audits revealed inconsistent implementation and low-use of signage despite higher self-reported use, indicating survey bias and a knowing–doing gap
Addressing Informal Caregiver Burnout in the United States: Policies, Interventions, and Recommendations
Get PDFInformal caregiver burnout has been and will continue to be a significant public health concern in the United States, necessitating a comprehensive analysis of initiatives and policies to reduce its negative impacts. This paper provides an overview of existing approaches to address caregiver burnout at the individual, community, and national level, identifying critical gaps in policies and programs. By highlighting successful approaches in other developed countries, this paper presents comprehensive program and policy recommendations to strengthen informal caregiver support systems in the United States. Prioritizing these proposals can guide policymakers in creating a more supportive environment that values the crucial role of caregivers and improves their overall well-being. The paper concludes that to effectively address caregiver burnout, it is essential to implement integrated, wrap-around services tailored to the diverse needs of caregivers and ensure ongoing program evaluation. It emphasizes the need for the U.S. to re-evaluate its fiscal priorities related to public health by increasing caregiver support, especially given the growing elderly population and their increasing care needs
A Tale of Two Organizations: San Francisco & Tokyo, An Analysis of Urban Youth Poverty in the Developed World
No full textThis study analyzes the experiences of low-income youth in terms of their access to educational opportunities in connection to their social mobility, the study focuses on two highly prosperous cities: San Francisco and Tokyo specifically dwelling into some affected population groups and overall neighborhoods where low-income populations are clustered in. The study delves into youth poverty as a complex phenomenon facing communities and its direct implications for the lives of youth in the context of educational experiences and its connection to socio-economic outcomes. By focusing on two organizations addressing this issue in each of the contexts, the study highlights interventions, programs and approaches that seek to break cycles of generation poverty and, by engaging local communities, offer support systems for youth as they endeavor to meet their aspirations.
Results: Both non-profits use community involvement both at a local community level and even at a corporate level. As a result of having deep community roots, both non-profit organizations involve their students’ parents or guardians in their students’ journey from high school and beyond. Lastly, both organizations help their students beyond high school into their professional careers. Involving the local community and helping students in their professional careers provides us with an example of not just the individual abolishment of poverty but a generational abolishment of poverty
Effects of Communication Boards on Improving Communication In Assisted Living Care Facilities
No full textProblem: A Residential Care facility utilizes paper charting causing limited access to vital information such as code status, allergies, and/or diet for those caring for the resident.
Context: Exceptional charting only when a resident’s condition changes may not provide enough vital information for the caregiver to administer medication or provide proper support during an emergency, such as the resident’s DNR status.
Interventions: A communication board was placed in a secure space near the nurses’ station with key resident information. Nurses would huddle at the board at before the change of shift and make updates as necessary.
Measures: Staff input in designing the board was done prior to chart review. Vital information was added to the board. Training of nurses and medication technicians was completed on how to use the board. Direct observation and coaching by the CNL confirmed proper documentation on the communication board each day.
Results: The implementation of a communication board in a Residential Care facility provided a sustainable and impactful method for improving communication, enhancing patient and resident safety, and fostering staff collaboration. Staff will continue to modify the board to meet the needs of staff and residents.
Conclusions: A simple cost-effective method of ensuring communication between staff members in a Residential Care facility can enhance patient safety and foster trust among family members and staff, especially during emergencies where critical information is needed quickly
Reducing Nulliparous, Term, Singleton, Vertex Cesarean Birth Rate
No full textAbstract
Problem: Cesarean birth rates for nulliparous, term, singleton, vertex (NTSV) pregnancies in the United States continue to exceed the Healthy People 2030 goal of 23.6%, resulting in preventable maternal and neonatal complications and higher healthcare costs.
Context: This quality improvement (QI) initiative was conducted in a high-acuity labor and delivery unit in California’s Central Valley, an area characterized by maternal health disparities, high rates of comorbidities, and limited access to prenatal care. The goal was to reduce the NTSV cesarean rate to 18.0% by July 31, 2025.
Interventions: Guided by Kotter’s 8-Step Change Theory and the Plan-Do-Study-Act (PDSA) framework, interventions included implementing a Labor Support and Cesarean Decision-Making Checklist, conducting structured interdisciplinary huddles, enhancing staff education on non-pharmacological pain relief methods, optimal patient positioning and improving workflow integration through a Labor Support Cart and visual patient identification tools.
Measures: Outcome measure focused on the NTSV vaginal birth rate. Process measures include documentation of labor support techniques. Balancing measures assessed NICU admissions and operative vaginal deliveries to ensure patient safety.
Results: Since the implementation, the NTSV vaginal delivery rate was 17% in May and increased to 29.90% in June, with an overall average of 22%. Non-pharmacological labor support was used in 43% of cases, and labor support techniques during the second stage were notably high at 76%. NICU admission and operative delivery rates remained within safety parameters.
Conclusions: The project is ongoing, and data collection is in progress. During the quality improvement project, the following was observed: standardizing labor management through interdisciplinary collaboration, structured communication tools, and non-pharmacological labor interventions produce mixed results and replication.
Keywords: NTSV cesarean reduction, labor support, non-pharmacologic interventions, checklist, quality improvement, interdisciplinary collaboration, maternal outcome
Enhancing Client Intake Efficiency in the Removal Defense Program: A Nursing-Led Quality Improvement Initiative
No full textThis quality improvement project focuses on optimizing the intake process for the Removal Defense Program at a nonprofit immigration legal office serving asylum-seeking clients. The existing intake relied on unstructured, phone-call-based intake interviews that gathered incomplete information, leading to inconsistent documentation, reduced efficiency, and significant client processing delays. A structured, multilingual, and multiplatform new-client admission protocol coupled with the implementation of a client-facing resource guide for waitlist clients were co-developed and implemented using the Lippitt Change Theory framework. Utilizing a mixed methods approach, the study involved staff interviews and observational assessments with staff members from the program. Baseline intake process satisfaction rating by staff was 6.5/10, prior to the implementation of new screening and intake procedures. After implementation, intake satisfaction scores improved by 5%, and staff reported reduced time spent on form clarification. Staff also expressed their satisfaction with the utility of the resource guide. The cost-benefit analysis projected a return ratio of 11.5:1. This intervention demonstrated a sustainable, low-cost model for improving intake operations in under-resourced legal settings. Despite the limited implementation time and number of clients the intervention was applied to, the overall project success supports the broader application of nurse-led systems redesign in non-traditional, community-based environments