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Impact of a Screening and Resource Intervention on Social Determinants of Health Outcomes among Mental Health Patients in the Emergency Department
Full text linkObjective This study evaluated the impact of a social determinants of health (SDOH) screening and resource connection for adult mental health patients in the emergency department (ED) on identifying the SDOH needs of the ED mental health community, connecting patients with resources, and the outcomes of ED utilization and boarding.
Method A quasi-experimental, pretest - posttest design was employed. Participants were screened by emergency nurses to identify SDOH needs. Patients who identified a need were connected to resources. A two-week follow-up was offered to evaluate resource connections.
Results There were 36 patients who agreed to participate of 51(70.5%) who were screened. The most prevalent SDOH need identified was transportation (58.3%, n=21). More than one need was identified by 69.4% (n = 25). A SDOH resource intervention was received by 91.6% (n = 33) of participants. Participants were difficult to reach for follow-up. Receipt of SDOH services were reported by 66.6% (n= 8) of participants completing follow-up. Participants reported resources as very helpful (55.5%, n = 5) and 100% (n = 10) of participants completing follow-up endorsed continuation of the program. Emergency department visits and boarding hours were significantly lower in the 3-month post intervention for the participants who received a resource intervention.
Conclusion Mental health patients have SDOH needs driving health outcomes and ED utilization. Addressing SDOH needs in the ED may lead to less ED utilization and boarding hours. The ED is a viable location for SDOH screening and resource interventions
Peer-to-Peer Feedback: Professional Development to Improve Feedback Skills
Full text linkBackground: Peer-to-peer feedback is the most essential form of communication as it encourages nurses to evaluate the quality, safety, and effectiveness of nursing care amongst peers. Poor communication skills for providing feedback is a barrier identified in the literature, which can be addressed in professional development training.
Purpose/Specific Aims: The purpose of this quality improvement project was to evaluate the effect that a communication-focused professional development session had among new graduate registered nurses (RNs) as it relates to their self-efficacy to successfully provide meaningful, constructive feedback to peers aimed to improve communication skills.
Methods: This project utilized a modified General Self Efficacy Scale pre-survey, PowerPoint® presentation, professional development educational intervention and the same modified General Self Efficacy Scale post-survey one month post intervention. 12/25 participants completed the modified General Self Efficacy Scale (GSES) before and after the educational session. Descriptive statistical analysis was used to calculate and analyze the pre-and post-intervention GSES scores utilizing percentiles and total mean scores.
Results: Twenty-five RNs attended the peer feedback professional development session, 12 of the 25 nurses (N=12, 48%) completed both the pre- and post-GSES survey questionnaires. The results showed a significant difference between the mean pre- and post-GSES scores for all participants. The mean pre-GSES score of all participants was 18.8%. The mean post-GSES scores of all participants was 22.8%. There was a four-point increase between the mean pre-GSES score and the mean post-GSES score.
Conclusion: The communication-focused professional development session for RNs increased their perceived self-efficacy to provide feedback to their peers. Based on Bandura\u27s self-efficacy theory, achieved through the session, participants increased perceived self-efficacy to provide feedback which will influence their ability to participate in successful delivery and acceptance of feedback during peer-to-peer feedback
The Role of the School Nurse in Reducing Human Papillomavirus (HPV) Vaccine Hesitancy: A Pilot Quality Improvement Project
Full text linkBackground: Vaccine hesitancy among students and families is a pervasive challenge for school health professionals, leaving the school community at risk for vaccine preventable disease. All states have vaccine requirements for school entry, and the school nurse is responsible for communicating with caregivers regarding the completeness of the immunization record. The human papillomavirus (HPV) vaccine was first approved in the Unites States (US) in 2006 and is an underutilized primary prevention strategy.
Purpose: The purpose of this pilot quality improvement (QI) project was to measure the effect of evidence-based educational interventions on the knowledge and confidence of school nurses when discussing HPV vaccinations with students and caregivers.
Methods: This pilot QI project was performed through a pre-test/post-test design measuring knowledge and confidence in HPV vaccination focused on a group of 14 school nurses in Pawtucket, Rhode Island, an urban New England school district. Participants engaged in a professional development (PD) presentation, to build knowledge and confidence in discussing HPV vaccination. Data were analyzed using paired t-tests in R Studio (Version 4.0.3).
Results: Statistically significant increase in both knowledge of and confidence in the HPV vaccine was found in pre and post test data.
Conclusion: This pilot QI project has important implications in increasing school nurse confidence when engaging with students, families, and caregivers
ICU Liberation Bundle: Nursing Attitudes and Potential Barriers to Implementation
Full text linkBackground: Intensive Care Unit (ICU) survivorship is often marked by lasting complications such as delirium, morbidity, debilitation, and increased incidence of 6-month mortality. Aside from direct organ and life support through critical illness periods, this survivorship remains a key area of opportunity for improved outcomes through evidenced-based intervention. One such intervention is the ICU Liberation Bundle, a package of elements proven to improve survivor outcomes. The literature is abundant with evidence for its effectiveness, but also speaks to lack of universal implementation and whole-bundle compliance at the point of care.
Purpose/Specific Aims: To explore barriers to ICU Liberation Bundle implementation and overall nursing attitudes towards the bundle and its five elements.
Methods:,/b\u3e Education sessions on ICU Liberation Bundle to ICU point of care nursing staff were followed by focus group style interviews using open-ended questions to explore perceived barriers and standard care divergence from the bundle. Analysis was conducted using inductive thematic analysis as described by Nowell et al. (2017)
Results: Nurses have mostly positive perception of the bundle and its elements. They consider the early mobility element as the most divergent from their current practice and commonly identified staffing/resource availability and concerns for patient safety as barriers to implantation. Family involvement was also cited as divergent with similar barriers to implementation.
Conclusion: Nurses agree with most of the outcome-centered mission and elements of the bundle but perceive staffing as a barrier to full implementation. Further investigation is warranted to confirm or refute these findings
Can Bowel Rest and Early Postoperative Eating Be Equal Methods In Ileus Prevention? A Systematic Review
Full text linkPostoperative ileus is a type of complication that is commonly seen in colorectal patients in a hospital setting. It is known to be a prolonged absence of bowel function after surgical procedures, usually after abdominal surgeries. Prolonged impairment can lead to patient discomfort, dissatisfaction, and prolonged hospitalization. Historically, strict diet protocols have been followed by patients who have undergone gastrointestinal and abdominal surgeries. Oral intake of food or water would be prohibited until there was a signal of returned bowel function. A patient\u27s progression in diet would not commence unless a patient passed flatus or stool. Patients who undergo abdominal surgery may develop symptoms of nausea and vomiting, abdominal distention and delayed passage of flatus and stool. A slow progression in diet is followed to avoid an ileus. Research studies throughout the years have begun to challenge traditional care protocols. In newer protocols, such as Enhanced Recovery After Surgery (ERAS), patients are given diets earlier in their course in hopes of restoring bowel function. Much debate lies on whether bowel rest and early postoperative eating are equal methods in ileus prevention. The purpose of this systematic review was to answer the clinical question, Does early postoperative eating reduce the risk of an ileus in colorectal patients as compared with colorectal patients who wait for return of bowel function before initiating oral diets? Five final RCTs were selected in this systematic review utilizing PRISMA guidelines and CASP tool to ensure study integrity. Results of this review determined that early postoperative eating reduces the risk of an ileus in colorectal patients as compared with colorectal patients who wait for return of bowel function before starting oral diets. Postoperative patients can achieve optimal health and independence, if there is an understanding of the patient\u27s basic needs and the factors that can cause an ileus. Through evidence-based practice, APRNs can provide support and guidance to nursing staff and patients in achieving effective care and improving patient outcomes
A Mixed Studies Review: The Effects of a Ketogenic Diet on Cardiovascular Disease Risk Factors
Full text linkOne of the biggest risk factors for premature death and disability can be directly attributed to diet and yet it is not something that is not made a priority in every day life. Risk factors for cardiovascular disease include dyslipidemia, high blood pressure, elevated hemoglobin A1c, and obesity. Recently, diets that are considered to be low carbohydrate have become increasingly popular, with special attention to the Ketogenic Diet (KD). Ketogenic Diets have been researched for it\u27s effects on neurological health. Given that the KD is a high-fat, low carbohydrate diet, investigations of potential risks associated with the KD have been explored. The purpose of this master\u27s project is to conduct a mixed studies review on current published literature to evaluate the effects of a ketogenic diet on cardiovascular disease risk factors. Six studies were included in this mixed studies review. The findings of this mixed studies review demonstrated that the ketogenic diet decreased risk factors for cardiovascular disease. Measured variables included: high density lipoprotein cholesterol (HDL), low density lipoprotein cholesterol (LDL), triglycerides, blood pressure, body mass index (BMI), and hemoglobin A1c. This mixed studies review did demonstrate favorable results for the reduction of cardiovascular disease risk indicating that the KD may be suggested for risk reduction by the Advanced Practice Registered Nurse (APRN)
Assessing Nurses\u27 Knowledge of Alcohol Withdrawal: A Quality Improvement Project
Full text linkThere is a growing prevalence of patients with alcohol use disorders who have the potential to develop alcohol withdrawal syndrome (AWS), especially in the hospital setting, where patients with alcoholism abruptly stop consuming alcohol. Hospital nurses are at the frontline and are in a unique position to care for patients with AWS and thus should have the appropriate understanding and knowledge to recognize, treat, and prevent further complications of AWS. However, there continues to be a knowledge deficit among nurses caring for this patient population. The goal of this quality improvement project was to increase nurses’ knowledge on the care of patients who experience alcohol withdrawal. This was completed through targeted education for nurses utilizing a pre-test, educational intervention, and post-test design. Fourteen of the possible seventeen nurses participated in the pre-test (N=14, 82%) and sixteen of the seventeen nurses participated in the post-test (N=16, 94%). The educational intervention combined information from an extensive literature review in the form of a 10-minute Power Point presentation. Pre and post-tests were made up of ten knowledge-based, multiple-choice questions. The mean scores for the pre-test were 80.7% while the mean scores for the post-test were 91.9%. There was an 11.2% increase in nurses’ knowledge following the educational intervention. Despite the low number of participants, this project revealed a positive correlation between the educational intervention and nurses’ knowledge. This project aimed to recognize a need for ongoing education for nurses about alcohol withdrawal in the hospital setting. APRNs play a pivotal role in establishing and implementing educational programs and in ensuring improved nursing knowledge and patient outcomes
Increasing Emergency Department Nurses\u27 Knowledge of Targeted Temperature Management: A Quality Improvement Project
Full text linkCardiac arrest is a serious medical condition that has a high mortality rate. Currently, there are limited interventions that are known to increase the chance of survival. One recommended intervention is the use of Targeted Temperature Management (TTM) which involves inducing a state of hypothermia post resuscitation and return of spontaneous circulation (ROSC) following cardiac arrest. This procedure is complex and requires use of specific equipment and close monitoring. At times, this procedure is initiated by nurses in the emergency department (ED). TTM is a low-volume, high-risk intervention. The purpose of this quality improvement project is to enhance Emergency Department (ED) nurses\u27 knowledge of TTM initiation procedures and hospital-specific policies and guidelines. Following an extensive literature review, a clinical pearls quick reference guide was created to act as a readily available resource for ED nurses implementing TTM. Prior to distribution of the clinical pearls quick reference guide, ED nurses will be asked to participate in an educational intervention, as well as a pre- and post-test to determine current and subsequent knowledge of TTM implementation. The desired outcome of this project is an increase in ED nurses\u27 knowledge of current TTM protocols and an increase in confidence in TTM implementation in the ED setting
COVID-19 and Global Security
No full textTerrorist groups are most active in developing areas of the world and thrive on instability. The ripple effects of the COVID-19 pandemic has increased unemployment and poverty while decreasing economic output and government efficacy in the developing world. I argue that these effects may have the secondary effect of leading to more violence involving terrorist groups and other non-state actors. Using a global sample of data on non-state violence from the Armed Conflict Location & Event Data Project (ACLED), I find a statistically significant and positive relationship between COVID-19 deaths and the number of battles. I also present a case study of the Lake Chad Basin in Africa’s Sahel, the region of the world most afflicted by terrorist attacks, to identify the effects of COVID-19 on increased terrorist activities
Utilizing Evidence-Based Best Practices in Reducing Second and Thirdhand Smoking-Related Morbidity and Mortality in Children
No full textBackground: Exposure to environmental tobacco smoke is a leading cause of respiratory illness in children. Although evidence-based best practices to improve outcomes are well-documented, they are inconsistently implemented.
Purpose/Specific Aims: The purpose of this project was to improve provider implementation of evidence-based best practices in environmental tobacco smoke exposure reduction in children. The overarching aim was to reduce related morbidity and mortality. Specific aims included increased knowledge and skill related to best evidence-based practices, and fostering implementation in practice.
Methods: This project involved a quasi-experimental quality improvement design involving an educational intervention on the scope and nature of the problem, the potential for impact, and evidence-based strategies to enhance the feasibility of intervention in the office setting. Differences between pre and post-test outcomes were analzed. A second follow up post-test was implemented at 1-2 weeks post-intervention to assess improvement in practice.
Results: Of 56 eligible employees, 31(55.4%) attended the presentation. The average pre-test score of 4.31 out of a total of 5 demonstrates a strong baseline knowledge. The average post-test score was 4.67 demonstrating a significant improvement (p \u3c0.01).
Conclusion: The project’s resulted in significant improvement in provder knowledge, and uptake of best practices in environmental tobacco smoke exposure reduction. This improvement was consistent regardless of role or area of practice. The average pre-test score of 4.31 out of a total of 5 demonstrated a strong baseline knowledge and was consistent with state-wide performance in smoking reduction. There was strong participation engagement with 55.4% of eligible employees attending