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Addressing the Opioid Epidemic in Minnesota: Improving Health Outcomes by Expanding Harm Reduction Strategies A Prospective Policy Analysis
Full text linkBackground: Morbidity and mortality from opioid misuse is worsening in Minnesota, and synthetic opioids have exacerbated the public health problem for vulnerable communities. People who inject drugs (PWID) due to social, health, economic and environmental factors are experiencing increased fatal overdoses. Minnesota has a broad approach to tackling the opioid crisis, but policies are needed, using new harm reduction strategies, to address the existing gaps.
Methods: A prospective policy analysis was conducted using a public health and trauma informed approach using an extensive literature review to understand ways to improve health outcomes in PWID. A Center for Disease Control policy analysis framework was used comparing two policy options: safe consumption sites (SCS) and expansion of Narcan utilizing public health vending machines (PHVM).
Results: Both policy options were found to be beneficial, feasible, and cost-effective approaches which would increase enrollment in addiction treatment services and decrease healthcare costs to society. Implementation of a SCS pilot study and PHVM, into areas most affected by the epidemic, would reduce overdose deaths by increasing access and availability of life saving treatments. Three repeating themes appeared in the analysis: language, stigma, and research.
Conclusion: A multi-pronged approach can improve MDH opioid epidemic response. Innovative harm reduction policy inclusion and expansion is critical to reduce overdose deaths and must be on Minnesota lawmakers’ policy agenda. Inclusion of affected populations in policy development is vital. Properly framing the issue and use of first-person language is important. Further education and health communication programs are needed to reduce stigma among all stakeholders. Evaluation research of utilization patterns will strengthen evidence for the further expansion of new policy solutions
Impacts of Makerspaces and Design Thinking on Creativity in Third-Grade Students
Full text linkThis action research aimed to determine the impacts of makerspaces and design thinking on student perceptions of creativity. The study occurred in a rural North Dakota third-grade classroom during science instruction. There were two sections of 17 and 18 students, respectively. Students participated in makerspace activities, including designing and constructing their own paper house or school. Data was collected through pre- and post-surveys, an adjective checklist, and teacher observations of student behavior. Pre-assessment findings suggest students had a relatively positive view of creativity before the intervention. Findings suggest student perceptions of creativity improved following the intervention. Further research on the impacts of makerspaces and student creativity should be implemented. When students take ownership of their projects and learning, genuine engagement and creativity flourish
The Impact of Dialogue Journals and Circles on Social and Self-Awareness in 6th Grade
Full text linkThis action research project aims to measure the social and self-awareness of 6th grade math intervention students in a suburban school in central North Dakota from the end of January to the beginning of March 2023. This study focused on two methods to promote student-teacher relationships and build a classroom community. The two methods employed were Circles for whole group activities and Dialogue Journals for individual correspondence between students and teachers to build that relationship. Surveys were done before and after the six-week intervention to gauge student perceptions on their own emotions, academic, and social-emotional activities in school. Students were interviewed after the intervention to collect qualitative and quantitative data on their opinions about the activities in the intervention. This study concluded that students see the importance of Social Emotional Learning and enjoy building relationships. All schools and communities that play a role in the development of children need to take time to teach and practice Social Emotional Learning
Implementing Hands on Training for Air National Guard Registered Nurses and Emergency Medical Technicians
No full textProblem: Air National Guard Registered Nurses and Emergency Medical Technicians often lack exposure to hands on training, regarding the medical skills required for deployment, which can affect their preparedness to support the Air National Guard’s federal and state missions.
Purpose: This quality improvement project aimed to determine if hands-on-exposure through the use of simulation, increased the confidence of one Air National Guard unit in Mississippi.
Method: A single group, pre- and post-survey design was used to compare confidence levels for Registered Nurses and Emergency Medical Technicians of the Air National Guard unit receiving hands on exposure to their required comprehensive medical readiness skills through simulation. The simulation was designed around the comprehensive medical readiness checklist, which consists of six skills and ten pieces of equipment, the participants rated when they last had hands-on exposure to each skill and equipment. Additionally, the participants rated their initial confidence level to perform the skill or use the equipment if deployed, and rated their confidence level post exposure to hands on simulation.
Findings: Registered nurses and emergency medical technicians showed an overall increase in confidence levels regarding their deployment readiness skills and equipment after using simulation as a form of hands-on exposure. There was a 27.8% increase in exposure time with 100% of participants stating they were now exposed to the skill within the last 2 years, yielding an overall increase in confidence levels of 30.5%. Additionally, there was a 30.5% increase in exposure time with 79.2% of participants stating they were now exposed to the deployment medical equipment within the last 2 years, yielding an overall increase in confidence of 33.4%. At the end of the project, 91.6% of the participants strongly agreed/agreed that the simulation opportunities provided had better prepared them as Air National Guard registered nurses or emergency medical technicians. Additionally, 91.6% of participants stated they felt the simulation opportunities helped increase their confidence to perform the skills and use the equipment the Air National Guard requires for them to deploy.
Implications for Practice: Military registered nurses, and emergency medical technicians must perform many skills they may not have hands-on exposure to in their civilian or daily job. Military nursing leaders should acknowledge that their personnel may lack the confidence to perform all required skills required to deploy. This project demonstrated that hands-on exposure through simulation increased the confidence of RNs and EMTs performing skills in an Air National Guard unit
Educating Reimbursement Specialists About Plagiocephaly: Improving Efficiency of the Prior Authorization Process for Providers, Healthcare Staff, and Patients
Full text linkDeformational plagiocephaly (DP) is a condition in which an infant’s head becomes deformed and flattened because of molding forces that manipulate the malleable cranium. DP is very common, impacting an estimated 46% of infants within the United States. The resulting asymmetries of the head and face carry implications for functional, social, and emotional interactions. Helmet therapy is the recommended treatment for persistent moderate-to-severe plagiocephaly. It is most effective when started before six months of life with decreasing correction as the child nears one year old. Helmet therapy is very effective but is also expensive, and insurers have highly variable policies such as prior authorizations (PA) for reimbursement. The PA process is lengthy and requires substantial administrative and clinical effort from craniofacial advanced practice providers, including nurse practitioners and physician assistants. Insurers frequently require a peer-to-peer discussion, which is a conversation between the craniofacial provider and an insurer-designated medical provider to discuss reasoning behind the clinical recommendation. This is very time consuming and presents a significant administrative burden for the craniofacial provider. The process delays the initiation of helmet therapy, which may negatively impact patient outcomes. This quality improvement project, aimed at improving the prior authorization process, occurred over eight months within a mid-size pediatric orthotics group located in a large urban area in the Midwest. It included the creation and integration of a written brochure tool that was utilized in the PA process. Craniofacial providers and staff completed a pre-and-post-implementation survey assessing their perceptions of the tool’s impact. Additionally, data on insurer communications and outcomes were obtained before and after the tool’s implementation. Results indicate that the educational brochure (1) significantly improved response times from many insurers, thus improving access to helmet therapy for patients, (2) decreased the number of peer-to-peer requests, thereby decreasing the administrative load for the craniofacial provider and expediting access to therapy for patients and (3) ultimately was correlated with increased prior authorization approval. Although these results are limited by several variables, they demonstrate that proactive insurer outreach resulted in significant improvements in PA timeliness and administrative burden. For similar insurer-mediated delays, results suggest that it may be beneficial to facilitate proactive outreach to insurers
Montessori Parent Education: Supporting Early Childhood Independence through Social-Emotional Learning
Full text linkThis action research project evaluated how a one-time parent education session focused on emotional coaching and social-emotional learning affected children’s independence in a small, private Montessori preschool. During the five-week study, children’s task independence and self-management at home and school were assessed by parents and teacher, respectively. Parents reported greater confidence in supporting children’s independence and emotion regulation following the intervention. Both task independence and self-management levels were high at school. While task independence at school did not increase due to parent education, task independence increased at home. There was a trend toward increased self-management at home following intervention, and two of the five intervention group children also showed greater self-management at school. Results suggest that even in a school where parents are educated about the practical steps of supporting children’s independence, teaching parents how to support children emotionally has additional positive effects
DNP Project - Improving Communication in Rural Healthcare via a Daily Leadership Huddle
No full textBackground: A Midwestern rural health system piloted a 30-day leadership huddle to improve leader communication regarding critical events and situations affecting patient and staff safety. The pilot allows multidisciplinary and multi-level leaders to come together each day, focusing on the safety of their patients and staff. Utilizing Kotter\u27s Change Model as the theoretical framework, the nurse-designed and led pilot focuses on raising leader awareness about incidents in the previous and upcoming 24 hours that could affect patient and staff safety. Pilot elements include a voluntary pre-survey, a virtual daily huddle call that leaders have on their calendars as an appointment and a voluntary post-survey. The pre-and-post-Likert survey, completed by huddle participants, assesses their perception, feelings, and attitudes about communication of critical events before and after attending the 30-day huddle. The Chief Nursing Officer guided the 15-minute virtual huddle, attended daily by approximately 74 participants, capturing critical events and situations, some requiring investigation, follow-up, and the dissemination of learning for others to mitigate future occurrences.
Results: Leaders unanimously demonstrated increased satisfaction with communication post-huddle versus pre-huddle. The average daily participation rate at the end of the pilot was within 8% of the participation rate for weeks 1-4, indicating the information shared via the huddle was valuable enough for leaders to attend daily.
Conclusions/Recommendations: Communication failures contribute significantly to errors in healthcare. We will continue the daily leadership huddle based on the unanimous leadership team survey results indicating the perception of better communication after attending the huddles
Providing Sensory Modulation Education to Shelter Staff Serving Adolescent Survivors of Sex Trafficking
Full text linkDespite recent efforts to improve services, survivors of sex trafficking (SST) have numerous unmet support needs and barriers to achieving optimal quality of life due to the effects of complex trauma and other mental health diagnoses. Supporting the recovery journey of SST is an emerging practice area for the field of occupational therapy. Sensory modulation in particular is one intervention within the scope of occupational therapy that has shown promise as a bottom-up approach to support regulation and participation in meaningful occupations. A training module on sensory modulation and a Sensory Toolkit resource were developed and delivered to staff at Brittany’s Place, a youth shelter serving SST, in order to improve the quality of support shelter residents receive. Content was informed by literature review along with informal interviews with staff to ensure relevance and feasibility of tools. Adult learning principles and best practices were applied throughout development and delivery. The training was delivered in hybrid format, and a survey was administered to evaluate effectiveness. Results from the surveys indicated that there was an increase in knowledge following the training. Responses also indicated that staff generally felt that the materials were relevant, and felt confident in their ability to apply the training content and to utilize the Sensory Toolkit. Findings from this quality improvement project support continued collaboration between the site and occupational therapy capstone students in order to support carryover of the training content. The project also highlights the potential for occupational therapy’s inclusion on interdisciplinary teams in this area, and the need for continued advocacy for this type of collaboration
IMPROVING THE QUALITY OF DISCHARGE TEACHING IN THE EMERGENCY DEPARTMENT: IMPLEMENTATION OF THE TEACH BACK METHOD
No full textProblem Statement: 78% of patients do not completely understand their discharge instructions, which can lead to decreased patient satisfaction, higher anxiety levels, poor medical outcomes, repeat emergency department visits, and higher overall healthcare costs. Additionally, nurses and medics report that they do not feel that they receive adequate education on how to provide appropriate and effective discharge teaching.
Purpose: This project aimed to increase the knowledge and utilization of evidence-based discharge teaching techniques among military emergency department nurses and medics.
Methods: Participants completed a learning style inventory, and then were taught about evidence based practice and the teach back method. Pre- and post-intervention surveys were done to evaluate knowledge, value, and implementation frequency of evidence based practice and discharge teaching practices.
Results: This group showed a strong preference for visual and sensual learning. The teach back method was utilized in 279 (23.6%) out of 1,185 patient discharges, compared to 0% of discharges prior to this project. Statistically significant improvement was observed in the knowledge and implementation of evidence based practice, and frequency of the teach back method. Patients verbalized an appreciation for this teaching method.
Conclusion: Using the results of a learning style inventory to guide the development of educational content is an effective way to improve knowledge and encourage practice changes in this group of emergency department nurses and medics